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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- --------------------- ' (Complete in Triplicate) Permit No. I L Date - This Permit Ex yes I Year From Date Issued Dais Issued��.-� __�.(; 1 p' 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: JOB ADDRESS/LOCATIOfN,k/Z }TT - --- ---- � '_�1'J n/ ,CENSUS TRACT -------------------------- Owner's Name --------L._. -_.4------- - ,Q.✓1� 4Phoned- I Address �C�_ _.. �_Gs/f..------ --- ------------ city'eVA/ _ '• Contractor's Name -✓_ -: - ---=----- .License � Q Phone��3- G _� _- /j^ __- Installation will serve: Residence ❑ Apartment House°❑ Commercial ❑Trailer Court !❑ j Motel ❑Other Number of living units:.__ -------- Number of bedrooms _Garbaga Grinder/--`--d __._,Lot Size ---------------------------------.---..__-- Water Supply: Public System and name ---------------- -------------I---_ ------------- Private Character of soil to a deptli�of 3 feet: Sand'71."'Sift❑ lClay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe © Fill Material y type __ if es, t e --- -------------------- -- � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed,on reverse side.) Q NEW INSTALLATION: (N11 septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth ------ ------------------- n 1 Cakpacity -- Type :-------- Material---------------------- No. Compartments ------.___....._...._. ! -------- Distance to nearest: Well ----------- --- -----��-----------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE No. of Lines ------- -------- h-of each 'line---------------------------- Total Length ---------------------------- R 4. Type D� Box _____- ---- T e Filter Mategal --------------------Depth Filter Material .._--.--------------------------------------- Distance __-__-__- -Distance to nearest: Well -_.________.!i--------- Foundation ------------------------ Property Line ________________________ SEEPAGE PIT [ ] Depth -------------------- Diameter -- J---___-___ Number __________________ Rock Filled Yes ❑ No l❑ Water Table Depth --------- --------------I-----------------------Rock Size ------.7. QpJJ �-- 5jr Disp ante to nearest: Wel! --------------- _______________________Foundation ______.C______-C_ Prop. Line ______ REPAIR/ADDITION(Prev. Sanitation Permit# -•-------------- -------------------- Date ---------------------------------- Septic ----------- ------------ --_-----Septic Tank (Specify Requirements) �/5 /� _�� Disposal Field` Specify eq`irements) --l �R-- :�_.r � �'1 -- ` ----- r� =-- -� ,�u.- ---- i-sp �- - ---------------- --------- ! - r� r t 1 •-v �sari� ---- --------------------- -------------- --_ h (Draw dxisting 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 Daws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: I "I certify that in the perForinance of the work for which thin permit is issued, I shall not employ any person in such rn r to 9 - - i--------------�I -- ------------------------------------------Kalifornia." � f as Signed become subject to Workman's Compensation laws of 4�- Owner By --- - t_-1 --- ---- " Title 'a ----------- (I other thanl�owned t FOR DEPARTMENT USE ONLY APPLICATION IOACCEPTED -------- ---------- E -. DATE ----- 1 ------------ BUILDING PERMTSSUDB . _� �0 ]=----------- ---DATE ------------------------------------------ ' ADDITIONAL COMMENTS -( - -------------------------------------------- ------ t ------------------ --- - ------ - - ---------- ]------------------------ --------------------- ---------------------------------- } ---------------------------------- ----- -=---------------- -- - ------ l- -'-- - -- --- Final Inspecti bi-- -- - - ---------- ---- -- ------------- ------ ------------------------------.Date W! --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M I - ,