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FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT ------------- ---- ---------------------------------- (Complete in Triplicate) Permit No. ------------------------------------------------------ _____________________ This Permit Expires 1 Year From Date Issued Date Issued/?_^ -� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application isvvl --made in compliance with County Ordinance No. 5 9 andFxist'ng Rules and Regulations: .-_ JOB ADDRESS/LOCATION cr� �-- _._-- -- --'--IIY ' �I - --- - - - --tom-r NSUS TRACT -------------------------- Owner's Name --- Lj --------=- ----------- ------Phone ----------•--------_-.._.,...... Address L. > F 411 s3 --LI/ City -1.5a� ----------------------------------/----------- Contractor's Name _. fJ- --------------------------------------License #A,01,2511Z_._-_ Phone -- ----- ��.. Installation will serve: Residence Apartment House[] Commercial ❑Trailer Court [1 Motel ❑Other -------------------------------------------- Number of living units:--- ------ Number of bedrooms -__---.Garbage Grinder _,eVa__ Lot Size �_--6.01110-------------I...... .. WaterSupply: Public System and name ------------------------------------------------------------------------------------------------------------._Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ,$ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe ❑ Fill Material ------------ If yes, type ---------------------------- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} >� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer`s available within 200 feet,) {„ PACKAGE TREATMENT f ] SEPTIC TANKjK Size_ _ ______________ ________ Liquid Depth ___ . Z. 1 Capacity J✓ if�/. Type�f� __ Mafierial��/Tz__.___ No. Compartments __ ______________ O,Q Distance to nearest: Well --- --- ------- Foundation -r/'-----------___ Prop. Line -2.47------------ LEACHING LINE �Q No. of Lines ----A____________.__ Length of each line_ // ` �� f>� - - -- Total Length --------•------- D' Box _ __4!ti_ _ Type Filter MateriallrQjDepth Filter Materialle---------- �l �.m o Distant to nearest: Well _ __.loco____________ Foundation S07i__________ PropertyLine __ _ SEEPAGE PIT Depth �--_------_--- Rock Filled Yes,' No 0 �_ Diameter _��_____ Number ______ __ le Water Table Depth ------f - -----------------------------------Rock Size _ ___,3 - -------------- Distance to nearest: Well . lP-----------------------Foundation _- ----------- Prop. Line _, __ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ---___.___ Date __________________________________) Septic Tank (Specify Requirements) --------------------------------------------------------------- DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- --------------------- ----------- ---I----------------------------- ---------- ----------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------- - - ------------------- ------------------------------------ Owner _J BY --- Title Ey (I er than ownerf FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------- -------------------------- DATE ............. BUILDINGPERMIT ISSUED --------------------------------------------------------------- ------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------ ----------------------------- --------------------- --------•- ------ ----------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ---- --� ----- - - ---- - -- - - ---------------------------------- - ---- -- ----------------------- --------- Final Inspection by: -- ------------- ---- ------ --------------------------------------------- -Date _/1 --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M