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FOR OFFICE USE: APPLICATION EOR SANITATION PERMIT (Complete in Triplicate) Permit No. ------------------------------ -------------------------- This Permit Expires i Year From Date Issued 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 wit /qty Ordinance No.54 and existing Rules and Regulations: JOB ADDRESS/LO ION ._/- O� 0----------'""-----J}�r/_'ew, ---- ! --CENSUS TRACT -------------- ----------- Q Owner's Na _ ��QS.S ------------------------------------------ - - Phone �+ '�_ _?, 1-X-Q, ' �+.n-r/1� I'1------- -------- City _/4-�N _ ---------------------------------------- Address ---.100-7.3 Contractor's Name -------------------------------License # ____ Phone`,_�06057"7-_96j�L7 Installation will serve. Residence Apartment House,❑ Commercial {-]Trailer Court ;❑ Motel ❑Other ----------------------------------------•--- Number of living units----I------ Number of bedrooms _CR------Garbage Grinder ---— Lot Size --- '-------------- Water Supply: Public System and name ---------------------- ------------------------------------------------------------------------------ ---------Private; ' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay jam' Peat❑ Sandy Loam ❑ Clay Loam ❑ .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 [ I SEPTIC TANK'[ j Size------------------------------------------------ Liquid Depth _------------_------,----- O Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -------------- ....... \ Distance to nearest: Well -----------------------------------Foundation ---------------------- Prop. Line ---------------------- -, LEACHING LINE [ ] No. of Lines .__.___f_____-__ Length of each fine_____ __0______________ Total Length _____-__41U.._____._ 'D' Box ------ ----- Type Filter Material Depth Filter Material ------ -------------------------------- Distance ---__.______________________Distance to nearest: Well --- 0--------_--. Foundation ------1.6)----------- Property Line ----- ............. SEEPAGE PIT [ j Depth _(9,!T_9 (9,!_9------ Diameter ------- Number --------l----------------- Rock Filled Yes,[> No ] Water Table 'Depth --------- --------i----------------Rock Size ---- C ------------------- Distance to nearest: Well -----------��___________________Foundation ------r_r7_------ Prop. Line _47----------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ----------------------------------------------------------------------•----------------------------------------_--------------- ----------- DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------- --------------------------------------- ---------------------------------- --------------------------------------------------------- --- (Draw existing and required addition on 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." Signed .__._ -- Owner -------------------------------- - BYf d? ---L - .-- S TitIe /*----------------------------------------------------- than owner) F EPARTMENT USE ONLY ��yy APPLICATION ACCEPTED BY -- ------ ---------------------------------------------------------- DATE ------- = Z /--�=---- BUILDING PERMIT ISSUED -- - ----- - - ------- - ---------------------------------------------- DATE ADDITIONALCOMMENTS,_ - -- --- - - ------ -- --- ------------------------------------------------------------------------�-/--'------------------------------------- - ?=��:— ---------------- ---a fiF c�------ !f7^ g Q�J/xlr p�.. r --------------------------------- - -------- -q/ f---E�-------�--- ------ ----- -- ------------------------------------ ---------------- ----- -- ---------------------------------------------------------------------- -------------------------------------------------- -- --- Final Inspection by: - _-- Date __ --,� -= ------ j N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 R 5M