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F R OFFICE USE: -11, 1 APPLICATION. FOR SANITATION PERMIT ----------- �y f Permit No.Z�r.J.769- ------------ _ (Complete fn Triplicate) "' Date Issued -------------------- --- --- ------------------------ ----------- ---�___ This Permit Expires 1 Year from pate issued -`f•-•• . 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 incompliance with County Ordinance-No. 549 and existing Rules and Regulations: JOB .ADDRE I`. " SS/LOCATION G�SIE : --- ---CENSUS TRACT ------------- Name ------`-{��_., _c _ -, ----- i � r'1_fn ------------------- Owner's ---------------- Phoned Address -----tF-Lo_' vcity -------- - _ ------------s----------------------------------- Contractor's Name-/.__- ' --_;�- License # 4!d��c�J� 'Phone - Instollation will serve: Residence X A artment House Commercial Trailer Court Apartment ❑ 0 Motel ❑Other --i----------- ------------------------------- Number ---------------- F _ g Garbage Grinder Lot Size Number of living units:_ Number of bedrooms,__ Water Supply: Public System and no __-___- - ,✓� -------------- --- Private ❑ ► Character of soil#o a depth p�f 3 feet: Sand' Silt Cla r ❑ ❑ y ❑ 'Peat 0 -'Sandy Loam ❑ Clay Loam '❑ Hardpan ❑ Adobe-[XI Fill Material : _____ r If yes, type ----; --- --------------- (Plot ---- --- ______ (Plot plan, showing size of lot,' location of system in relation to wells, buildings;,�etc, must be placed. on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is-available within 200,feet,} j PACKAGE TREATMENT { ] SEPTIC TANK:[ - -- � { l -Size------- ` -------- Liquid Depth ----- -_7I ' Capacity .. TYPe --- ----`---- --- Material---------- f-- No. Compartmets __-•---•---- Distance to nearest: Well ------- - fCNIII � Foundation Pro Line ---------------------- LEACHING ) �. d� p' LINE �� No. �of Lines 1 g ~'� I -------- -----------•_-- Len th of each line----.----.-------,� -- Total Length --------_-- 'D' Box ____-/ ___ Type Filter Material ------- _______Depth Filter _Material------.____�.� Distance to nearest.-Well..-.__: :-=- foundation1�---------- Property Line -----.�10-----•-•- SEEPAGE PIT Depth _-_- _ __ Diameter _ �� Number - _____ - _- R ck Filled Yes (] No�r Wate`'r Table Depth _ iz c Distance to nearest: Well ---- --"--------- ------Foundation _ Pro --�-�-}----•- - p: Line ........ REPAIR DITION(Pre Sanitation Permit# .-4_,=.-.___ -___-___ -___ - r'F j I; I" ,Date ----------------------------------} Septic Tank (Specify Requi ements) '------------------------------------`_--_--- - -------------------------------------------------- ----------------------- ---- Dis posal Field (Specify Requirements) E' (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 Laavirs, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or liven- { sed agents signature certifies the following:. _ "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 of California.,, r Signed ------ -•---------------- --'-I--- Owner ;I`----------a-------------------------------------- By ------ - - - - -------------- ----------------------------------- Title ----C ' '{If other than owner) I�. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYII_- - �_,� . . 1 .' __._:_---------------------------------- --= DATE -----f1=��=7f BUILDING PERMIT ISSUED =r = _ ?;�, --- -------- -- ---DATE ----------- ADDITIONAL COMMENTS /_<3ezL----- --- d --- --------- ----------------------------- -------- --------------------------------------- --- ---=1--------- -------------------- - ------------- ---�----- ------------------------------ Final Inspection by: ------- li------------ --------- ----.Date ----'C �,l ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �`