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FOR OFFICE USE: v LICATION FOR SANITATION PERMIT Permit No: -- ----------------- ------ ------------ --------------- (Complete in Triplicate) ---- - --- ------------------------------------ -------- DateIssued f-,",&-i --- 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ._ ---_ - r --- -- __.CENSUS TRACT -----------------•-------- Owner's Name W-6114-4----/+1,A ( i --- -------------------------------------------------------- ---Phone ---------------- --------• -------- AddressCity - --------------------------------------------------- Contractor's Name -A-71 i.a- -------- ----- '°a--------"------------------- ------=--------License # ------------------------ Phone ---------------------------- Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court C7 Motel ❑ Other ---------------------------- --------------- Number of living units:............ Number of bedrooms 3---------Garbage Grinder ---------- Lot Size -_------------------------• r Water Supply. Public System and name -------------------------------------------------------------- ----------------------------------------------Private-F Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam:] Hardpan,] Adobe'❑ Fill Material ___________ If yes, type -----_________________-_.__ (PI'ot plan, showing size.of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) s'eepage pit permitted if public sewer is available within 200 feet,] 1 . NEW INSTALLATION: (No septic tank or N PACKAGE TREATMENT { ] SEPTIC TANK Size-_i -k____Ok?�---5-------- ------ Liquid Depth -�____----------------- Capacity- 1�_------- -- Type =1 �--Material. _. __-- No. Compartments --_________________ {� Distance to nearest: Well _...5_I7____:____ --------------Foundation ._ ------------- Prop. Line . "" $.__:__--.--_ 1 LEACHING LINE] No. of Lines ----I------------------- Length of each line-----J__"�----- --------- Total Length 1-iiV-------------------- l 'D' Box ------------ Type Filter Material _f�-R------------Depth Filter Material ____1$`_-- Distance to nearest: We ---- Foundation _______________ Property Line ""- ..-------.:_--- r SEEPAGE PIT .} Depth ___ - ---------- Diameter° ------ Number >I____________________ Rock Filled Yes ] No 0 Water Table Depth _ ----- - A-'------Rock Size ---------------------- ------------------------ Distance --------------------- - Distance to nearest: Well -F------------ ------ Foundation 0"------------- Prop. Line Zr---.. ------- IREPAIR/ADDITION(Prev. Sanitation Permit=# -------..-------------------------------y--- Date --___________.___..---------------) t Septic Tank (Specify Requirements) ----------------------------------------- ------- .--------------------------- Disposal Field (Specify Requirements) Y r " ---------- ----------------------------------- t" . .v --------------------------------------�_'-------- ---------------------------------- .- - -fir {Draw existing and required addition on reverse side}_-` b 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 ownef or licen- sed agents signature certifies the following: i "I certify that in the performance of the work for W'. this permit is issued, I shall not employ any person in such manner as to beco subject to orkman"s Compensatio s of California." �� f r Signed L:------------------- By --- Owner ---- --------------------------- ------------------------ Title ---- - ------------------------ ------------------- ------------------- (if other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED _ ------------------------------------- BY - = DATE _7=_l " -- --- - -- - - - -- ------------- BUILDING PERMIT -ISSUED ---------- -------------- ------ ----------- - --------------------------------------DATE ---------------------------------------- - - { ADDITIONAL COMMENTS --------------------- ------- = ----------------------------------------------------------------------------------------------------------------- -------------------------------- --------------------- ----------------------- ------- ------------------------------- ----------------------------------- -------------------------------- ---------- ------------------------------------ ' Final Inspection b arm. ----------------------------Date �� SAN JOAQUIN LOCAL HEALTH DISTRICT a E. H. 9 1-'68 Rev. 5M