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a J FOR-OFFICE USEAPPLICATION FOR SANITATION PERMIT / Permit No- --------------- ---- --------- (Complete in Triplicate) Dt Issued ---a C1_-._7..v -- -------=-'"- p This Permit Expires 1 Year From Rate issue ---------------- A --cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein PP )-cation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. J described. This app CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION ._- 5---7�'3----- -- (qL— --- T Phone Owner's NameALlt ------------------------=---------------=------- Address ------ --------------------- ------- ------------------------ City ----------- - ' -cense # �_5"�'"--77-� Phone -�--��--�-` Contractor's.Name " _ -- -- �' n ` Installation will serve: Residence [Apartment House❑ ConVnercial ❑Trailer Court i❑ Motel ❑ Other ------•------------------------------------- Number of living units:---- Number of bedrooms " -----Garbage Grinder_. - Lot Size ----------•---- i. --_-__Private I - -- ---- --- f - Water Supply: Public System and name -------------`------------------- - " " - ... Clay Loam 1] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ 'rPeat ❑ f Sandy Loam ❑ Hardpan E] Adobe E] Fill Material --`--- 1f 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 ifipublic sewer is available within 200 feet,) = ----- .Liquid .Depth --------- PACKAGE ------- (� PACKAGE TREATMENT { ] SEPTIC TANK:[ ] Size-------------_-- =-- ------ __ No.< Compartments ------. ---- V Capacity -��-�p-=��TYpe -------------------- Material" ----- ---.---- - ... p ----------.Foundation -1 d-------- ----- Prop. Line --------- Distance to nearest: Well -____�o�~------- �_"- Length of each line._--- $-�- Total.,Length -----//--"" ---- LEACHING LINE [ ]K No. of Lines'"___--- �l �» ------ -FS � -'i" De th Filter Material ------------- ---------------------- ' 'D' Box -r --... Type Filter Material ___ .-:1------ P �j,_J _ -ca-. r'- - t -----.-"--- - z. y Foundation"_L_._---""_-- Property Line. ----------------------- W -- --- - f Distance to nearest: Well"_. s"�--- - SEEPAGE PIT [ } Depth --------- ------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 WaterTable Depth ------------------------------------------------Rock Size -----------------.-------•------ -Foundation --- Prop. Distance to nearest: Well --------------------------------- - p -------------- -- - ------- -- ---- ------------- Septic Tank (Specify Requirements) _------- Date ----------- -----------------•-- I REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------- -------------- ------------------------------------ --- ------- Disposal Field (Specify Requirements ------------------------------- - ------------ ---------------------------- =------------------------------------------- -�-- ---------- " (Draw existing and required addition on reverse si e 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 owner or licen- sed agents signature certifies the following: person in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any as to become subject to Workman's Compensation laws of California." Signed - - ---------- - - ------------------------ --------------------------------------------- Owner itle - - --------- - ----- -- -------------------------- T ----------------------- �y . r (If other than owne FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------- - ----------------- DATE �`�=ZQ�".--- --------------- BUILDING PERMIT ISSUED -------------------------- - -- DATE -------------------- ------ -------------------------------------------------------------------------------------- ADDITIONAL COMMENTS-------------------------------------------- ------------------- -------------- --------- -----------------i -- - - -------------- ----------- 1_4_4a-_Date Final Inspection b ---- - --------------------- - - - SAN JOAQUIN LOC EALTH DIS ICT a05- to—eZ I E. H. 9 1-'68 Rev. 5M