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FOR OFFICE USE: - ' -APPLICATION FOR SANITATION PERMIT '1 � ---------------------------- mit No. 7d._-Si� (Complete in Triplicate) .. ------------- -----------------------------------------I This Permit Expires ] Year From Date Issued Date Issued -S�k`--72. ' S,�$''D i W- F-l 644'T M f op- AA } 0&'7- O LfU•-O to !ppfication 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: JOB ADDRESS/LOCATION .__vf �lc�_�Sj- r1Q____ _ E�� 1 "Il� ___ S ��Gl._______CENSUS TRACT -----�"_6________ t Owner's Name -- ---------- -- ----------------------------=- -------Phone --------------------------•----... Address -------- / �� ------ City ---------------------------------------------------------------------------- Contractor's Name _�,en--F--------------------------------------------------------------------------License # ----- -- --------------- Phone --------------------------- - Installation will serve: Residence ❑Apartment House Commercial�❑Trailer Court '0 Motel ❑ Other _-1X-) __-QUAQ-------------- Number of living units----- Number of bedrooms ___________Garbage Grinder ------------ Lot Size __Nzx� --------------------------- Water Supply: Public System and name ----------------------------------------------------------------------•---------------------------------------Private) Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay ❑ Peau Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ------_----------------_____ Q (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,p�r I�bI yv-t in 200 feet,[1, / 91/ PACKAGE TREATMENT { ] SEPTIC TANK' Size_ ___ ___nn ._____---D-K_w___u_�tiquid Depth ----- __ -----------.___.____ Capacity - -� -�f3 Type -------------------- MateriaklgVQ r- \�No. Compartments __t ___._._.____-- uu Distance to nearest: Well _. a__ ______Foundation ----�-Q_FT_____ Prop. Lin _____.7!.f-T____ LEA.40 No. of Lines __ _ _ _________ Length of each line------"10-tav--_---- Total L ngth ___4. _____--_ . -_IX Y Depth Filter Material ____�._ D' Box .._ -- Type Filter Material _ p _______________•-` �. Distance to nearest: Well Rt4c_ _ Foundation -z-1- ------ Property Line ___ ------ SEEPAGE _-_SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No C) 1 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line _-______--____ REPAIR/ADDITION(Prev. Sanitation Permitf -------------------------------------------- Date ----------------------------------) I/&il Tank (S e i# e uir # IL /fi�Nl I t ) --- -- ---------------------------r� y �pp�� al`Field (Specify Requirem�fis) ______�_. /AAl __�_____�___ � � DG-_��s� {__ ------- ,r ---------------- -- ------ - ' (Draw exis#in 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: "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 y BYa �--------------------------- Title ......... --------- (lf other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --�A ------------------------------ ----------- - - ---------- DATE --- ---------- --- BUILDING PERMIT ISSUED ---- ---- ----- ---- _ DATE - ADDITIONAL OMMEN S ----------- �1�12E' fes' ."' / - ---------- _ -- _ _ -- -------------------�-- ------------ ' ` - . -rte -- -----71b---- ��:e- - ' 9 2�:-7 -------------- - -- -- - - ---------- ---- -- ---- II'Li,4W--------------------------------------------------- Final Ins ection b ______________Date SAN J AQUIN LOCAL HEALTH DISTRICT !nY E. H. 9 1-'68 Rev. 5M : , '