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1 FOR OFFICE USE: _- `APPLICATION -FOR SANITATION PERMIT Permit No ------ ----- : -��= (Complete in Triplicate) : 7 ---------- Date Issued------------------- ----------------------- 5 ---------------- - .`--z-- --- __--- 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 incompliance with County Ordinance No. 549 and existing Rules and Rigulations: JOB ADDRESS/LOCATION . ti+ .0J0 -- . - ---- ---'_C SUSjTRACT - 1 Owner's Name ------- - - -- Phone " �i-�,.�-.. �_ �` o` .. -------- ------'---------------------------------- Address --- -- --- - - -r--- - --- ------- -------------- CitY ----- -- Contractor's Name ._______C _ __ - -:-----��--- -------.License #PW7d-.-7.f--- Phone/76;"age` r--�? Installation will serve: Residence e Apartment House Commercial :❑Trailer Court i❑ Motel ❑ Other ---------------------------------------------` Number of living units:_______ Number of bedrooms _______Garbage Grinder ------------ Lot Size me - --------Private Water Supply: 'Public System and name ❑ Character of soil to a depth of 3 feet: -'Sand'❑ Silt{:] Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ � t Hardpan ❑ Adobe Fill Material ------------ if 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,) PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] �Sri,4<"Size-------------------------------- - --------- Liquid Depth =-- --------•.---------- Capacity -------------------- Type -------------------- Material--------------- No. Compartments- ------_--- Q . Distance to nearest- Well ------ -------------------•-.-----Foundations-------------------- Prop. Line --------------- -----11 - - -i-LINE �]° No. of Lines { ------_i---- Length of each line.__ ----------- Totals Length .___ ___._ 7 'D' Box --, _ -- Type Filter Material _A�_ -----Depth Filter Material ---1-- -------------------------- ---- Distance to nearest: Well Foundation _/p---r----------- Property Line -=---------------. ----- SEEPAGE PIT [�' Depth g7-L1"_�------ Diameter Number -------f---------------- Rock Filled Yes No 0 Water Table Depth ------- Q ---------------------Rock Size ---111.7---------------. .. Distance to nearest: Well _Foundation -- �/-_--_---- Prop. Line ....5 REPAIR/ADDITION(Prev. Sanitation Permit}# .--j----101----------------------------------- Date ---------------------------------- ' ) I�-_ SepticTank (Specify Requirements) ----------------------------------------------------------------------------------- --------- ---------------- ,.------------ n r Disposal Field (Specify Requirements) � - - G 7 - ' ---- `-------- --------------- ----------------------------------- ------ -------------------------------- --------------- ------------------------------------------------ ------------- ----------------------------- - - - - (Dr.'aw existing and required addition ori reverse side) 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: { "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." r r _ Signed --- --------------------„--------.------- ---------------------- Owner ' BY c t _ -----------------Title -`------ --- (If other than owner) FOR DEPARTMENT USE ONLY e APPLICATIONy ACCEPTED BY R= = - r' = = DATE __�`� "'Z-"?7--) L-r BUILDING PERMIT ISSUED - ==-------------------- ------------------- - ----------DATE ------------------------------------------- ADDITIONALCOM) .ENTS -------------------------------------------------;---------------------------------------------------------------------------------=----------- ------------- a � a. _ - ------------ ------------- ------ --------- -------- -------- ------------------------- ------- ------ -- R, - ------- ------- Final Ins ectiodb r. P Y - = ----------Date -- -="-��--- ---------------- ------- " C] SAN JOAQUIN LOCAL HEALTH DISTRICT E. N. 9 1 '68 Rev. 5M �` Vr