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I FOR OFFICE USE: a FOR SANITATION PERMIT APPI,lCATIO em -------_---- _ � Permit No. .----:- f_____________ plete in Triplicate) ---- - wM1 .- ,:� . ��w e- Date Issued -----------__-.--- This Permit-Expires 1 Year From 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 C ty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N ` i "- 1J°'- - --------------- -----------------------CENSUS TRACT ----------------------•--- Owner's Name ----- ----- -----i --A--------------------------- Phone = d�- Address = JF'" 1K,414- = it -- --- ........................... ---- ------------------ Contractor's Name --` License # -�S �"'/ Phone , Installation will serve: Residence ❑ Apartment House-❑-Commercial ❑Trailer Court ;❑ Motel ❑ Other --------------- ----------------------------- Number of living units:____ � Number of bedrooms ___ arbage cinder - c7_.-_ Lot Size _.___ ._-- - - -' Water Supply: Public System and name --------- - ---- �------- -- +------------------ - Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam El 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.) A" NEW INSTALLATION: {No septic tank or seepage pit permitted if public is available within 200 feet] I. .- ,— Li PACKAGE TREATMENT ( ] SEPTIC TANK'[ ] Size-------' ----------------------- ------ --- quid Depth -------------------------- ► Ca eacity---!r ;- -= Type -- -''--- Material---------------------I No. Compartments ------------ --------- DistiffSnce to nearest, _.---_ _---- ------- ---- --Foundation -- --------------------Prop. Line ----_---- `iof-Lines --- -------------- -�Leng#hi of each line__."`- -------------- ------ Total Length LEACHING LINE [ ] No Lf , I D Box ------------- Type-Filter Material --------------------Depth FilterMaterial -- ------------------------------------------ � Distance to nearest: Well ------------------------ Foundation -------- ------ Property Line ------------------ .----- e Dista _ SEEPAGE PIT [ ] Depth _._.__.- ----_ ._° Diameter` f_____________ ` Number - -------------------------- Rock Filled Yes ❑ No i❑ Water Tiabl Depth ------------------------------------------------Rock l Size -------------- -- ------------- - Distance to nearest: Well ___________-----------------------------Foundation --------- -- ---____ Prop . Line ----------=`-------- ----------- ,.r--ti_------REPAIR/ADDITION(Prev. Sanitation.Permit# --------------------- - ---Date,. -`---1 " }► I ' E t Septic Tank (Specify Req i ' 4 en!s) --------- �. -------- -- J1 F Disposal Field ( X. ,..Specify t� iremenfis). -jG.�-`t ---- - I - �. � � - f � � G � - -------------------------------t-------------------------- (Draw eFisting and required ad clition on reverse side) I hereby certify that 1 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 ' the performance of4pz work for which this ermit is issued, I shall not employ any person in such manner as to be m b' t to W ma s s f m , alI ornia." Signed ` ---- --- ---------- BY -----.---------- -------------- ---- ---- ---------- -- --•--:- --------- Title -------------------------------- ------------------------------------- `• (If other than owner) FOR DEPARTMENT USE ONLY T�2--- -------------- APPLICATION ACCEPTED BY ----------- - - --- DATE _..------------- 6 - --- - DATE - ------------------------ BUILDING PERMIT ISSUED -----�-.. � ------- '�"'�-----�:- - - --- --------- -----------=- --- - --------- ADDITIONAL COMMENTS _ _—� �6, " -- ---- ? - ------------------ --------------- ------------------- ---------------------------------------- -------------------------------------------------------------------------- ---------------------------------- -- ------ ---- ------------------------ ------------------------------ - ------------------------------ ---- --- - Final Inspection by; ------------- ��-------------------------------------------------------------------------------- -----.Date --- -�--�' ------- - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT t . E. H. 9 1-'68 Rev. 5M T;-