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FOR OFFICE USE: 3 APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: ---- /- p--- �- _______ Expires - This Permit Ex res i Year From Date Issued Date Issued .__��'�� �. Application is hereby mdde to the San Joaquin Local Health District for a permit to construct,-and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .---rJ� C} --- --- � _�_�' __..___ A � CENSUS TRACT �'_s�- `- � Owner's Name q. C1 �1�-- /_ _p�_ �------ ---- � Phone Address ------ � /Q'�------� W:S!r l Q_dv I - City r'?n lt } -- -------------------------------------------- Contractor's Name ___. s, I - - ------------ -------------- L---------------------------License # -------- -Z---------- Phone ------------------------------ InstaRation will serve:i Res idence.<iApartment House❑ Commercial:❑Trailer Co'brt ❑ ! -•------------ Motel �Other --------- ------ t // .– Number of living units:___ _______ Number of. bedrooms ___ Garbage Grinder. ____f�____ Lot Size _1_ ------©_ ___________________ Water Supply: Public System and name ----------------------- ------------------------------t '-------------•- _---------------------------Private Character of-soil to a d pth of 3 feet: Sand Silty Clay ❑ Peat❑ -Sand Loam Clay Loam _ ' 1 CS Y ❑ Y ❑ a + Hardpan ❑ Adobe'❑ �FilI Material ------4*j- 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;ta k or seepage pit permitted if ru Iie sewer is available within 200 feet,) 4 PACKAGE TREATMENT [ j SEPTIC TAW[ ] Size---------- -- ------------------- ----- Liquid Depth _------------------------- p L.Cap�ty�`7"-- ------ Type -------------- Mafieial______ o. Compartments Distance to nearest: 1'611 ---------------------------_ Foundation -_� ------ ---_ (pro Line -------•--- -__ LEACHING LINE [ j leo. b Lines ---------------------- Length of each line----------------------- ---_ Total Length ------•-------_----._------ F� .. . � 'D' BW ----- - Type Filter Material __________________Depth Filteaterial _____________.________________..--........_ � Distance to nearest: Well -_ _--___-__ :---_�--Foundation—____•D�-�__- __--__E Property Line .__________- SEEPAGE PIT` [ ) Deptl i _______ _______„Rock Filled Yes ❑ No 0 t er ---------------- Number .-------- - I I Water l ble Depth Rock Size -- --------- - _ iam l - --. - ------------- _ _ .. – r Distanco nearest: Well:` -- ----------------- ------ aundation __ __-- Prop. Line .---------------_----- �_. ------------- REPAIRADDITION(Pr'ev. Sanitation ermit# __ . __:'________________________ _____ Date ------ --- -- ______} :.. Septi Tank (Specify Requirementsl--'r--------------------------------___-- Disposal Field (Specify Requirements) ---- � _ eo� _ ------------- -------- �I�.- ----------4. t _ = .F-- ------------------------ -------------------�---------------------- - -- ----------- -------------------------- _. - ------------------------ -----_ ----------- - ++ (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: j --f— -1 "I certify,that in the pe ormance of the work for whit this permit is issued, I shall not employ any person in such manner as to be o e su Iect t Workm Compensation law of California.” Signed, __ M " : --- _ wrier r By ----------- --------------- ---------------------------------------------------77vs..--'-- ---- Title ----------------------------------------------------------------------- �(lf other than owner) FOR -DEPARTMENT USE ONLY APPLICATION,'\ACCEPTED BY ___T_<_ __'_0 --- DATE --- --`-- -•: � BUILDING PERMIT ISSUED -- -------------------- ------------------------------ --------------------- ------ - ---------DATE --------------------- -f---------- ---- ADDITIONAL CO- -N---T--S--_-_---- A -- - _e=– � _'tom_ _.. _. _ - — / _" 7 ---- - ----- - ------------------- ------- - -- ------ ---- 1 - y F --- --- - ----------------- ------ -- ---- _ ------------------ Final Inspectie --------------------------- - - ---------------------Date -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M