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I _ FOR OFFICE USE: --- _=tea = - -=°` y APPLICATION FOR SANITATION PERMIT ' a - - -- --------------------------------------------- (Complete in Triplicate) Permit No. -61_-3 4 ----------------- ------ -" This Permit Expires 1 Year From bate Issued � ._ a - Date Issued .".,f-`�- _G Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work..herein described. This application Asdm de in compliance with County Ordinance Na. 549 d existing Rules and Regulations: j e&00 t JOB ADDRESS�LOCATION '- "_-- �7L -_ — ' ENSUS TRACT --- -- - ------ - -/1j05'X—_iC Owner's Name ___ 1�z Address ,,, . ----- �j�- .' hone ? Cl�Z ---- ----- -----------• tY Cie „ P - Contractor's Name . ------------------ -----.License # "i x Installation will serve: esidence ❑ - Phoned-" L� -------------------------- R Ap'artment House Commercial:❑Trailer Court ❑ f, ' Motel ❑Other-"- I Number of living units:_--- ----- Number of bedrooms -_- `."Garbage Grinder Lot Size Water"upply: Public System and name ._-'------------- "" --- ---------- - -----------------------------------------•- --•---•------- Private Character of soll to a depth of 3 feet: Sand'❑ Silt❑ ClaI t Y ❑ Peat❑ Sandy Loam [] Clay Loam ❑ x Hardpan Adobe'❑ Fill Material ------------- I#yes type---------------------------- CN .._ ______-_""-""- - >_ . C (Plot .plan, showing size of lot, location of syster6-inrelationto wells, buildings, etc. must be placed on reverse side.) q' NEW INSTALLATIONe i t -- *`'r {No septic tank o, seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT '[ ) SEPTIC TANK f .� --.. ] 5iie ------ ---------------------------------- - Liquid Depth ---------- Ca Capacity `i "' p Y -- Type -------------------- Material---------------------- No. Compartments ....:.... •µR"`''� Distance to nearest: Well , _ � � 1�-� � �s_ aundaion. ---------- .Prop. Line LEACHING LINE [ ] No. of Lines ` i � .... Length of each"line"__-" --�*=------- -------- Total Length ---------- ------ i 1 .'kn D' Box ------------ Type Filter Material -------------- Depth Filter Material h*,_________ Distance to nearest: Well ---_---_--___--___ " -�'-� .� •" _ _-- Foundation ------------------"___-- Property Line -------------- ., ,SEEPAGE PiT .[ l Depth Diameter i ------ ---------------- Number �'.- ---- " . Rock Filled Yes ❑ No 0' Water Table Depth `----• "' =------------------------ -- Rock Size _`'_£ ._' _ ' _ ,. REPAIR Distance to nearest: Well ------------------- ------!-- -Foundation ----------#-- �'�r_ ,. ;Prop. Line ---•------- M DDITiON{Prev. Sanitation Permit#` ----- -------------------------------------- _ Date -------- - ) t'� Septic Tank (Specify Requirements) _L.2 ^` " - ' f :► # Disposal Field (Specify Requirements) - A ------ ` ` -------- S- ------- -------------------------------------- - - ------------------------------------------------- (Draw existing and required addition on reverse side)" " 1 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: "I certify"that in the performance o the'work for which this permit is issued, 1 shall not employ any person in such manner a as to be a su rect to W and j'Compe�!�"san laws of California." {Signed, 0 l t "" - --------- - - Owner BY - ------------------------ " Title (If other than owneF -- ' - - FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----_"_""-_ Kk 20 r T --- -------------------- ------ DATE BUILDING PERMIT ISSUED " - ----- -- ---- -- ----- ---- ADDITiONAL COMMENTS -- - DATE ----------------------------•------- -------- ----- -------- --- - -- --- - - ---------------------------------------- - Finai ins ection b - -- ----- -------------------- ------- ---------------------------------------- ----- --------------------------- " - - - ---------- ----------------- -Date - �-�2�- ---� SAN JOAQUIN LOCAL HEALTH DISTRICT r E. 11 9 1-'68=Rev,.;SM,