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FOR OFFICE USE. )(PPLICATION FOR SANITATION PERMIT l Permit No: 75_� (Complete in Triplicate) -- ---------------------------- � ------- ._ � This,`Permit Expires 1 Year From bate Issued Date Issued _-_:Z ___7_-v 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/LOCATION .----1-17yb------- -- -- ' -- -- Y ------- --- -----------CENSUS TRACT ----- --------------- Owner's Name ------------------- ---------�--�w ---------------------------------------------------Phone (A;_ &�3 7 Address rL� ------ ---------------------- ----- Contractor's Name ------------ a ------�__5�rel `-- License #L-C Sl i`----- Phone - 17... ' Installation will serve: Residence�6 Apartment House'C],Commercial :❑Trailer Court ;❑ __-___- NumberMotel ❑Other ---------------------------�____--____ Number of living C g 'units:____ of bedrooms _________Garbage Grinder --- ---- Lot Size _ -_ __ r✓�s --- ------------------- Water Supply: Public System and name - 1' -� _ ---------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E3f 'Peat❑ Sandy-Loam -❑ Clay Loam_❑ Hardpan ❑ Adobe Fill Matd`r`ial`------------ If yes,' type ____________________________ 5 (Piot plan, showing size of lot, location of system in relation to- wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepage-pit permitted if public,sewerris available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK`',[ ] 4.N -§ize--------- ------------ '------__ - - - - Liquid Depth -----------------•-•---•-- -t_V� .,Vt- r Capacity ------------ ----- Type�t--- --_.f---------- Material______________-----_ No. Compartments_ p = Distance to nearest:\)Nell ___':_�Y_--- `4---f ----t------Foundation ---------------------- Prop. Line -------------:-------- LEACHING LINE [ ] No. of Lines _____________ Length of each line---------------------------- Total Length _____-___ 'D' Box _ Type Filter Material __________________Depth Filter Material -------------------- ....................... Distance to nearest:-Wel! Foundation ________________________ Property Line -------------------____- SEEPAGE PIT [ ] Depth ___________________ _Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ ' Water Table Depth i--------- -`- ------Rock Size ----------------------------- ------------------------_- - --- FDistance to nearest: Well -----------------------------L- ------ Prop. Line -------------------•-- REPAIR/ADDITION(Prev. Sanitation Permit# _______________________________°_________ Date ________ ) �__ -'- '--- -------------- ' Y Septic Tank (Specify Requirements} ------------ --------------------•--- �-- ------------------ -.---------------------------- Disposal Field (Specify Requirements} C- � --- ------- - ------------ ---------------------------------------------- ------------------------ -1- __-_- ------------------------------------ - ----- ------------------------------------------------ (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- s sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner [ as to become subject to Workman's-Compensation laws of California. Signed -------- ----- - = = Owner O BY ---- ---------------------------- Title f = (if at r th caner) [ DEFOATMENT USE ONLY r APPLICATION ACCEPTED BY ------- -- - - - DATE ---1f�` =�7-a�--------------- BUILDING PERMIT ISSUED --------- -- ---- --- --- - _DATE ------------------------------------------- ApITIONAL COMM S ------- --------------------------- ------------------ ---------------------------------------------------------------------------------- ---- -- - - --------- -------------------------------------------------------------------------------------------------- - ---------------------- -- ------- ----------------------------------------------------------------------- -------------------- ---------------------------------------- ------------------------------- ----------- -- - ------------------------------------------------------------------------ ----------------------- Fina! Inspection by: --------- - ----- -- - -- ------ ---------------------------------------Date ------- v . y JOAQUIN LOCAL HEALTH DISTRICT E,sH. 9 1-'68 Rev. F f