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t-, FOR OFFICE USE: i APPLICATION FOR SANITATION PERMIT . Permit No: __7 = Z �Monfolete in Triplicate) .ae, ----------__------------------_------------ ------------- C. l Date Issued ----------------------------------------------- ---------- This Permit Expires 1 Year From Date Issued',P--; 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: ellCENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATION . ------�-='-1----- ''� , Owner's Name --- - --- --------- -----------------------------:-------- 9 ------ one7� _.... --- -------------- _ - h Address ---- x City ; �-- l - ----------------- Contractor's Name ----------------- --------- ------------=--------License #-r J� Phone 'j i Installation will serve: Residence14 Apartment House,❑ Commercial [-]Trailer Court ;❑ Motel ❑ Other -------------------------------------------- o . Number of living units:------ -- Number of bedrooms ____-yGarbage Grinder ------------ Lot Size r J Water Supply: Public System and name ------------------------------------------------------------------- ---------=---------------w---------- Private ' j, Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay-Loam ❑ Hardpan ❑ Adobe YL Fill Material :._�. _--_Nif 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 public sewer is available within 200 feet,) ,r PACKAGE TREATMENT [ ] SE%TANK ize------------ -- ------ - ---------- Liquid Depth --- -------------------� >-Capacit _ __-- -- Type - -------- -- ------ Material_ 11T -tom.--- No. Compartments -------- ---------... 5 Distance to nearest. Well -------- ---------------- -----Foundation ----- ----,------- Prop.;Aine -- ------ -----• -- LEACHING LINE No. of Lines --------/------------- Length of each line__/_Q =.y- ;w-,t-=- Total Length',.__/.q --------------- 'D' Box ------------ Type Filter Material Z _.--)J-k----Depth Filter Material ----- ------- ---• •- Distance to nearest: Well FOf f ------ Foundation _._-/0-_fi- ----- Property Line. ---5____ .---_- -- I t s of P ;< Depth Number ------ -��-------------- Rock Filled Yes No .id SEEPAGE PIT ;< Depth ____ S_______ Diameter __ �/ Table Depth --"Rock Size�..,":�= Z--------------------- Water i , Distance to nearest: Well 1a_�_ ________ _______ ------Foundation __ __0_--y`'----- Prop. Line _..5._ _.._--_-- ___.____ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------•-----) Septic Tank (Specify Requirements) ---=- ----------------"------------_ -------------- Disposal Field (Specify Requirements) ----------------------- -------------------------------------------------------------------------------------------- --------------- E ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- i ----------------------- ------------- --------------------------------------------------------------------------------------------------------- ---------------------------------------- (Draw existing and required addition on reverse side) I hereby certifythat^I haeme ptea�ed'this"application—aad-tFiat�The work wi11'be done'i„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' '�'+�` ° I "I certify that in the performance of_the work for whichthis permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." - y ! - Owner Signed -------- ------------ -------- Title ------- ' ------ ------------------------------------ r BY ----- --------- = s (If oth' t an owner) ( TMENT USE ONLY APPLICATION ACCEPTED BY -------- -- ------ ----------- --------- DATE ----- /_-7//=-7-- -------------- BUILDING PERMIT ISSUED -------- -- - - - ------- - -------- --- ---------- ------------------------ -------DATE --------------------------- --------------- ADDICQ4AM TS ---- ----- - +r d //fj / s �rcf y�-p ,. r1J off. j/ _ I , - - -- - = -- ------------- --------- ----------------------------------------------�------.---•--------------------- ---- - ------ - - ` Final Inspection bY- -------- - --- -- - Date -- �( N JOA QUIN LOCAL HEALTH DISTRICT i ' E. H. 9 1-'68 Re . 5M