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�FO OFFICE USE: �� 3-5—.. APPLICATION FOR SANITATION PERMIT e la/ " K----------- l- -rPermit No. - F'�.� (Complete in Triplicate) Date Issued _ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constr'uct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: pp �"' 11_i-S .-�--------CENSUS TRACT -------------------------- JOB ADDRESS/LOC�A�TI�ON/I�SQ -_ --- -�-�-• - - /� -� - � ""-" �/ p Owner's Name -"fit/,r 1 ✓- l��l ri (/ = Phone ?��J ��O_ AddressX': -------------------------• City -_-s '------------------------------ ------------------------ License # -`M_ .--------------- Phone r d Contractor's Name --------------------•-----------' 5�� -------------------- Installation will serve: Residence ❑Apartment House`❑ Commercial �❑Trailer Court ❑ Motel ❑Other/ 7�J Number of living units:----/------ Number of bedrooms --,Z---_Garbage Grinder -00 Lot Size -- _-___-_ ' -- Private Water Supply. Public System and name " -� Character 5 of soil to a depth of 3 feet. Sand❑ Silt❑ Clay .❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material -----"""--- if yes,type ---------------------------- t plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) {P10 p g (� NEW INSTALLATION: {No septic tank or seepage pit permitted if p bli sewer is available within 200 feet,) 1 SEPTIC TAMC Size-____-�` --" -,/-/------- Liquid Depth -----------•---------_-"-- PACKAGE TREATMENT [ ] I l Materi I E JSP No. Com artments ___"--.---" f Capacity --------- ------- Type ------------ ------ P - ---- --- -- // � P ��-------- # Distance to nearest: Well __ tC__ 4-------Foundation --f--p-------------- Prop. Line -------------____ ; No, of Lines �j�6-----_. Length of each line-"--___" �_ --____-- Total Length :"__ --- ------ h LEACHING LINE [ ] !/ �a 'D' Box --- -- Type Filter Material _I{l�------Depth /Filter Material ----------•-----------"---- ---------- •----- Distance to nearest: Well- _ "_?(Foundation r'a, %------- Property Line ___--�� -- �j �-/ - "_ ""_ Rock Filled Yes No .C3 SEEPAGE PIT [ ] Depth _�7----------- Diam ter -- --- __-• Number ""---""- -- -- -- Water Table Depth -------Rock Size -------------------------------- ------------ Distance to nearest: Well ._---""____--__ -- ""_--.-Foundation --------------- ---- Prop. Line -------------.-------- i REPAIR/ADDITION{Prev. Sanitation Permit# ""_"_--.-------__ ------ Date ---------------------------------- e -_ ""---------------------------I 'Septic Tank (Specify Requirements) ------------ ------ ---------------------------- ------------------- -------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------ ------------------------------- --------------- ---------- --------------------- ----------------------------------------------- -------------------------- -------------------------------- ------------------------------------------------------------------------ ------------------ ------------------------------------•- (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. Dome owner or licen- sed agents signature certifies the following: in such manner "I certify that in the performance of the work for which this permit is issued, ! shall not employ any person. was to become bject.t Workman' Campensati.on jaws of California." F�Signed s* . . . ------ -- Owner ------------- Title ---------------- r, {If other than owner) FOR .DEP T USE ONLY C APPLICATION ACCEPTED BY ------------------------ - --- - ------ ------- DATE _. ._�- ----- - -------------- ----- ----------- 'BUILDING PERMIT ISSUED ------------------------------------ ------ DTE ---------- -------- ADDITIONALCOMMENTS ----------------------- ------------------------------------------------- ----------------------------------------------------- ------------------------------ _ D "---� _ Final Inspection b Date N JOAQ N LOCAL HEALTH DISTRICT - , E. H. ) 1-'68 Rev. 51V1