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y FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT7�- -2' (Complete in Triplicate] Permit No. ---------------- -- ______________ This Permit Expires f Year From Date Issued nate 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 witCounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . 1. ------ - ' - -�, ------CE NSUS TRACT -------------- ----------- ---- Phone r ---------------------------- ��pm s}� l ------ - ___ __ _ Address --- �_L5 1/47--- -- ------------------------ ----------------------------------- ------ Contractor's Name _______________License # - - - -.12_ Phone ` Installation will serve: esidence ®'Apartment House�❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ----------``-------------------------------- Number of living units:_-____ ___._ Number of bedrooms _______Garbage Grinder ,----------- lot Size X Water Supply: Public System and name ------1 /' - !'!tZ0XU/ �(l,/1Q�7'-----------------------------------Private4w Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam=❑ Hardpan E]- -Adobe ❑ Fill Material _-:__.___mmlf yes, type -------------________________ (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 ublic sewer i available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK:[ ] Size___! _44t____ _ .___.__________________ Liquid Depth . ._.______________._. Capacity _419-P------ Type -_ � Material_____________________ No. Compartments Distance to nearest: Well __m0_------------------------Foundation ---------------------- Prop. Line _-- ------------- •--- LEACHING LINE [ ] No. of Lines ------------------------ Length of each,line__------____________________ Total Length/ � D' Box __yI------_ Type Filter Materi l --- Depth Filter Material _ a /------------- Distance _- __-_-__ Distance to nearest: Well:_____`Llv_ " Foundation _____ _.. t , jp Property Line -- I SEEPAGE PIT [ } Depth _ _______________ Diameter __________- __-_ Number ___.____- ----------------- Rock Filled Yes ❑ No .0 6 fWater Table Depth ----------------------------- ------------------Rock Size -------------------------------- Distance ---------------------------- fDistance to nearest: Well _______________________________________Foundation -------------------- Prop. Line __________-_..-_--____ W 1 REPAIR/ADDITION(Prev. Sanitation Permit-# -------.-------------------------------------- Date -----.._--___._____-___-__________) Septic Tank (Specify Requirements) ----------=---------------------------------------- ------------------------------•---------------------------,.` p 0 ` Disposal Field (Specify Requirements) -------------------------------------------------------------- I ------------=--------------•-•------------------------------ q ----------------------------------k-----------=- ------ -� i 4 _______________________________--------- ---------------------------------------------------- ► i (Draw existing and required addition on reverse side) y I hereby certify that I have prepared•this4application 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 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." Signed -------------------------------------------- ---. Owner �'J•� By -------------------------------- ---------I-------------------------------------------------- Title (If other than owner, - ---------------------------------------------- -� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- { -------------------------- DATE --- _- - -------------------------------------------------- - - BUILDING PERMIT ISSUED yi;e -- ----- -- ------- - --- DATE ADDETIONAL COMM ENTSt_j��(--- ---------------------------------- - --------- - --------------- J�d�---------------------------e------------------------------------------------------------- ---- py- - ---- ------- - -' - ------------------------------------------------------------------------------- ---- - --------------- 7---- ---------=---------- --- Final inspection b - �---- --------- -- - - - ,------- ------------------------..Date -- --- --fes - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1„'68 Rev. 5M