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x FOR OFFICE USE: # APPLICATION FOR SANITATION PERMIT I {Complete in Triplicate) Permit No. .7oX.7�......... - ----- ----------- 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 is made in compliance with County Ordinance No. 549 and existing Rules and ;Regulations: B ADDRESS/ CATION //I__ ---lrt►/_� i / I �1/ I� ----- :-CENSUS TRACT "' Owners --------------------------------- -------Phone Gts _'41 14? --- Address c vJ-7..�._+. __ / ,E f/ ®h-W01�41.0------------. city lt� fl' Contractor's Name ___�_ n/ -91�-- _ _ - x_______________ ______ _____ ______License �?3.�,a_,_ Phone X ,3=_ o " Installation will serve: Residence eApal ftrnent House❑ Commercial :❑Trailer Court �r 1'. a j Motel F-1 Othr- -- ----------------------------------------- F T i I '; I Number of living units:.-j------- Number of bedriooms ______Garbage Grinder _" ____ Lot Size __ -----------,__------ I - Water Supply: Public System and name -------------- _--___________ '; i '---------------Private -^ — —-� Character of soil to a depth of 3 feet: Sand' Silt Clay- -Peat Sand-..Loam la Loam Hardpan ❑ Adobe ❑ Fill Material ____________ If yes,typej___------------I __ (Prot plan, showing size of lot, location of syst�# in relation to wells, buildings, etc. must be. placed on reverse side.) t NEW INSTALLATION: {No septic tank or see age'11 ipit permitted i�public sewer is-available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size -X.. "x-1'�-_-__-_ Liquid Depth - ----------. ._.. Capacity/_-,'�_0,0______ Typ . _-Ad__ Materials /64, IT67 No. Compartments_ .................. ell �U -----------------------•Foundation - p-------) Prop. Line .r i I 0 Distance to nearest: LEACHING LINE [J� No. of Lines __+__ Length of each line�C___-______._____ Total t Length A��................ 'D' Boxy-__ Type Filter Material ��6�_____Depth Filter Material _��_____`_________________._..._._._ 1 / 1 Distance to nearest: Well _ _��__________ Foundation ! _ ____________ Property Line _............... SEEPAGE PIT [ ] Depth --------------------- Diameter ---------------. Number - -------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ----- Rock Size - . I � 'f , 5 . r. Distance to nearest: Well --1-------------------------------------Foundation -------------------- Prop. Llne ---------------------- REPAIR/ADDITION{Prev. Sanitation Permit# ------j- Date _____________._____-___-__- _w� ) Septic Tank (Specify Requirements) ______!-.-I----------------------------------------------------------- ) Disposal Field (Specify Requireiments) ____ -_ __ _____ i • j ___-__________ :-_ -- -------- --------- -------- ------------- ------ } --- =-" ` - ----------- ---- ------------------------------------------- ------ -- -------- --------------------------------------------------- `-=- `-------------- ----------------------------------- (Draw existing and required addition'ri`r`eveese side) I _ I hereby certify that I have prepared this application and tha£ the-work will be,done-in,accordonce 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 ;� k, "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'il California."`- SignedBy -- ----------I------------------------------I---------------------- Owner d --- : x --- - � --- -------------------- Title --- � �/_�� (If other than owner) I C ` I 1 FOR DEPARTMENT USE ONLY T!,4 ; t ,t 1 APPLICATION ACCEPTED BY ---- {�t -2-----------------------------=--- =--- w :----.-------_- _:__ _:.DATE ----- ` BUILDING PERMIT ISSUED --------- --'-- --------------------------------DATE ------- ADDITIONALCOMMENTS ------- ----------------- --------- --- ---- -------------------------------------------------- �. ------- ------------------------------------ ---------- ---------------------- ----- ------ - -- - - ----------------------------------------------------- --------------------------- ------- ----------=-------------- -------- ------ \ F .__ __ _ ___ __ __ _______ _ _____ __ _ _ _________ _______________________________________________ __1 --_ _ _ _._____.______� __ _ _______ _ _ _ i Fina tion b ---- ---------------------------------- 15'pa#e - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.9 1 '68 Rev. SM �+'' r` Wla" . _