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-� " FOR OFFICE USE: APPLICATION. Permit Na. FOR SANITATION PERMIT ---- - --------- --------- ------------------- (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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ' t --- � , CENSUS SUS TRA CTJOB ADDRESS/LOCA ION ISG _ ._--,._ Phone ------------------------------------ - 1C - ------- City -- ------- Owners Nam / 4 ----------- Address ---- � ------- - License # 14FK3 Contractor's Name =' Phone Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other --------------------------------------------- 14 .__- - Garb — age Grinder - ------- Lot Size -------------------------------------------- Number of living units:_-_j.__-_Water Number of bedrooms ___ ___ Water Supply: Public System and name ---------------------- ------------------ ------------------ ----- ---------------Private [ i. Character of soil to a`depth of 3 feet: `Sand' - Silt Ga 'Peat Sand Loam (�Clay Loam [ 'Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ----------------------_---_ k F (Plot plan, showing ksize of lot, location-of system in relation to wells, buildings, etc. must be placed on reverse side.) s NEW INSTALLATION-' (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTICTANK'[r� Size_ �_ _j�___s1'___�-_-fir._•.-----.__-._ Liquid Depth _. ------------ n Capacity _f�_c o. Type ......... ............... Material �. - No. Compartments p ._.. - f Distance to nearest: Well ------------ --------___-.--Foundation --------to-- ------- Prop. Line ---- -------------- LEACHING LINE [A!]� No. of Lines __-__,__ ----------- Length of each line----.-f__............. Total Length ..____l- _ 'D' Box -_ -___-__ Type Filter Material --- s._ ,-----Depth Filter Material ----- - - -------------- -- ---- ------ Z Distance to nearest. Well ______�� Foundation .-__1_ _�______ -- Property Line f-C Rirreterl�lL��_ Number -_ - _ Rock Filled Yes No i❑ s k [� Depth -------- �^ Water Table Depth --------------- {-----------------------Rock Size --�--'-�A----- fr ------- �.a I �, r } Distance to nearest: Well ------1-0-0------------------------Foundation -----�.0___-.-:-- Prop. Line --�-------....-___--_ C i REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic --.------- .-------Septic Tank (Spec-sfy Requirements) ---------------------------------------------------------------------------------------------:------------- ,---------------------------- DisposalField (Specify Requirements) --------------------------------- ------------------------------------- ------------------------------------------------ ----------- ------------------------------- ------------------------------------------------------------------------------------- ------------------------------- ------ ------------------ • f s (Draw existing and required addition on reverse side) f 1 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 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 t as to become subject to Workman's Compensation laws of California." Signed Owner ----------- 4P �- - . ------------------------- ----- -- ----------- Title _.------- -------------- (if ------ ----(If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . cwt _ - DNTE _.�* � 7 ----------------- BUILDING PERMIT ISSUED ----- ----- ------- l+SATE ------------------------------------------- ADDITIONAL COMMENTS --- -------- � .,"------ --�--- .._x1. Cv.------lf`,� t -------------- --------------- --------------------------- ' --------- ---- ---- ------------------------------------------------ ------------------------------------- --- ------ ---------------------- --- - ------------------------ ---------- - ------------------------------------------------- -------------------- ------ Final Inspection by: -------------------------------- -----------------------------Date _��-z`�_T.� ------------- -AL-,e,__ ! SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.