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V FOR OFFICE USE: 4 APPLICATION FOR SANITATION PERMIT i a 'IN pTriplicate) Permit No. ( {Com (Complete in --------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _10____—:3 1 Application is hereby made to.,the+SanJoaquin Local Health District fora permit to construct and install stall the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCA�TION --7NJ j� VIS ,, 1-------------U� J-0-til_------ .457-5-iRD----------CENSUS TR .457-5-iOwner's Name - 1- ---- --- -LLEAJ-------- ---------- ---------------- - -------------------Phone -------------------------------------- Address ----- -• •--Address ---------------------- License # _ Contractor's Name ,{ ------------ ------ - Phone ---------------------------_- Installation will serve: Residence)(Apartment House-[] Commercial❑Trailer Court ,❑ ` Ic-1111.R.-'Hotel ❑Other --------------- / / Number of living units:____ ` Niber of bedrooms ---/------Garbage Grinder _NA__ Lot Size Water Supply: Public System and n[me�_ ----------------- -_---__-_Vs____--_-________-•__---Private Character of-soil to a depth f 3 feel:. -Sand ❑ Silt❑ - Clay-,❑_;�P..eat- Sand. Loa. .:._Cfa Loam :� •- -Hardpan ❑ Adobe E] Fill Material WX _ I#w yes;type' --- ----------- (Plot plan, showing`size oflilot, o, anon of system in relation to wells, buildings, etc. �t be placed on reverse side.) S NEW INSTALLATION: (Noi septic ank or seepage pit permitted YZaXs c sewer is available within 200 feet) PACKAGE TREATMENT ' [ l SEPTIC'.TANKX Size__ ___________________ Liquid Depth Capacity _ ! ____ Type� C/Q_ TMaterial_OINCRIYTFIo. Compartments Z Distance to' nearest: Well °"0"___ Foundation _ _ _____-f_ Prop. Line ___ LEACHING LINE No��of Lines -------- _----------- Length of each line----._IA9__� Total Length ----�V49---_-__._--_ C' 'D' „Box ) Type Filter Materia J e ___Depth Filter, Material __� __ in # :_,s : Distance,to ; crest:Well ____.� __ �Qy`" -` Property. Line -____ D 3 — ne Foundation '0: 'sr� p rtY t SEEPAGE PIT [ ] Depth �--`-"" Diameter Number .____-:-- ic------------- Rock Filled Yes ❑ No I❑ Vater Table De th -L --------------------------- -------=-----•--Rock Size ------•------------------------- r ,- ist'nce to"nearest: Well------------------------•-----------------Foundation -------------------- Prop. Line ...........,---_,I, _ REPAIR/ADDITION(Preva San'tation`Permit# --.- ........ Date --.-----------------•-_______----_} Septic/Tank (Specify Requ'ilIff-ements) Disposal Field IS R uirements) I------- Mb 1 -- 11 == _ _ ,. ' ----------•------------ --------------------------------------- ' `II ------------- r ---------------------------------------- -------=------------------------------------- ---------------._ IV (Draw existing and required addition on reverse side) 1 hereby certify that ''I have' repared this application and thatQ the work will be done in accordance with San Joaquin County Ordinances, State Laws;and Rules and Regulations o4 the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies;[he;following'!" "I certify f in the performance.of the work for which this permit is issued, I shall not employ any person in such manner {. as to bec subject to Wor ompensation laws of California." SignedII ---------------------------------- Owner x By ------------------------------ ----------------------------}----------- I - ---------- ----------------- -- Title --------------------------------------------------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'�----------- !_ _ -�_ .------------------------------------------------------------- DATE ` =,7 ------ BUILDING-'PERMIT dSSUEDw - •r-4=-.--::_-__- -...�__ _ _ --------,---- ADDITIONAL COMMENTS __111 -- ---- ------- -------- -- -4 • _ _ - ----- -- ri - ---- ------ i ------------------------ --------- ----------r.,,r ------ ------------------- ------------ --------- = ------------- ----- ----- o --------------------------- Finaf Ins ion by: _ _ --------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 r 1-'68 Rev. 5M "