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FOR OFFICE L1SE: APPLICATION FOR SANITATION PERMIT 7�_ e,y z. Permit No- --------------------- -- -------------------- ------------------- -- - .__r------'- ---------- ----- - (Complete in Triplicate) ------------------------------ -------------- Date issued This Permit Expires 1 Year From Date issue A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de cribed, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION � Off------ 'D _��=L ----L 9i----------- -:--.-CENSUS TRACT _ _Phone -�-�-1-------d�/14977Z?/ NT's__. Owner's Name ,Cwspn! / Address -------------------1414.0 r ._ /.;--- ---- --- - ----•- --------- ---- City -------- -------------------- ----------• �G.'J — g�7+5 �j_Gff-NNU-T�_---L�O-- --------License #�"'- Vii_-V - ------ Contractor's Name ----�PL/W--At �`' Installation will serve: Residence p Apartment House'❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other ------------------------------------------ i Number of living units:_._/-_---_ Number of bedrooms __-,3-----Garbage Grinder -_ _ __Q_. Lot Size _.---- ---- - - r-iv-------- ---•------------------------------------- -------- - - - ---------------- - Private [ —' # Water Supply: Public System and name ___________________________ _ Sand Loam [Clay Loam .0 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Y �4 Hardpan ❑ Adobe ❑ Fill Material If yes, type ---------------------------- buildings, etc. must be placed on reverse side.} (Plot plan, showing size of lot, location of system in relation to wells, - ON: No septic tank or seepage pit permitted if public sewer is available within 200 feet,) NEW INSTALLATION: [ P i PACKAGE TREATMENT [ 7 SEPTIC TANK'[ ] Size----------------------------------------- id Depth ------------------------- - - Liquid . ----- No. ComP artments ---_--. ............... Capacity -------------------- Type -- :------------- Material----------------- r Distance to nearest: Well Foundation --------- ------------ Prop. Line -------------_-,--•--- ----- -------! --------- Length of each line-------'�� ---- - Total Length ------- D` --------- LEACHING LINE [� No. of Lines - - i� xn D' Box ___L----- Type Filter Material -.--------Depth Filter Material -----� -------- pistance to nearest: Well K� -p� -- +' Foundation _-_2-0`--_-____--- Property Line - --`--------------- F y •,t. Depth _.__�.S!---____ Diameter _44�--__--- Number .-___ - --`---------------- Rock Filled Yes Na i❑ SEEPAGE PIT [� P - \0. Table Depth ' -- - 'ti:�_.Rock Size ------------------------- Water `. Distance to nearest: Well -------Ad- -------------------Foundation _J_0- -•---- Prop. Line --- --------- Date REPAIR ADDITION(Prev. Sani#anon Permat - --- - ---------- epr Tank (Specify Requirements ______ _________________ ------------------- ----------------------- ------------------ Disposal Field (Specify Requirements) --------------------------- ------------------- - - --------------- -------------------------------- ----------- -------------------------------------------- ----------------------------------------------------------- ---------------- ----- - ---------- - [Draw existing and required addition on reverse side) - I .hereby:certify,.that.1 have prepared. this..application.Yand that._the work will be done it ordante with San Joaquin I County Orli ces, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed a encs sign tune certifies the following: ">' y t ' the performanche wor for which this permit is issued, I shall not employ any person in such manner ai o Work s Com sati.on laws of California." SOwner ------------------- ---- ----- -- - ----- --------------- -------------------------- Tifi e ..------- ------------------------------ ----------------- --------- - - _oi�er than other than owner) FOR DEPARTMENT USE ONLY k DATE ------ -------------------------------- --- APPLICATION ACCEPTED BY ----------------- --------- - --- ------- --------------- ------DAT -- ------------------------•-------- ----- BUILDING PERMIT ISSUED ------------------------------------------------------------------ - ADDITIONAL COMMENTS ------------------------ ------- -----__------------------------------------ ------------------------------------------------ ADDITIONAL ------- - -- -------- ------ -------------------------------------------- ------------------------------ -- ---- --------- ---------- ----- ----- - --------------- --- ------------------------------------------------------------- - -- ------------------------------ Date --- ------------------------- Final Inspection by: ------------------ ----------- -- - - --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT F- H_ 9 1-'68 Rev. 5M