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f FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. /. (Complete in Triplicate) _......................................................... �7 .. i?a.te_lssued_,,...`_... .__ ... . .; _ " This-PermitExpires ] Year From Date lssued`�___:_.... Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein I . described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION p .y --.. . .:' � ' CENSUS TRACT ...._._•.................. Owner's Name ... .. ..�----------I-r`}.1SO06. . ..----•-•................................................. ••---•--......_.. �.l?' ........................................ ... .... GAddress .. ..............................•-.........--•-•... City es Contractor's Name License #1.? j Phone f�.�,�� a�..... Installation will serve: Residence A Apartment House❑ Commercial❑Trailer Court C] l j Motel ❑Other ....._..................................... s Number of living units:-----L.---- Number of bedrooms ......Garbage Grinder //P:--_- Lot Size ...A ••-•--...— Water Supply: Public System and name ............. ---_--_...-- . -......_...... - _• ,•_ - ___ -: r- --------...Privatel' Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay.Loam ❑ -. •- :�-. ter— -�Hdrdj5dh [] o FiII M-ate`riai`�:..._.. yes, pe ----------------- (Plot _Y -----• • �— � (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,) x PACKAGE TREATMENT E ] SEPTIC TANK-[ ]i Size..........._._........... •....----.... Liquid' Depth ..._........._..........- CapacityType Material---------------------- No. Compartments -.-------.:..........- Distance to nearest: Well +.• .'..................Foundation ...................... Prop. Line ....:................. '= LEACHING LINE E ) No. of Lines ...................... Lengih of a each line............................. Total Length ............................ pQ Y� ` 'D' Box -------- --- Type Filter Material ..._ _-------......Depth Filter Material ........................................:... Distance to nearest: Well .......... ........... Foundation Property Line ........................ M ISEEPAGE PIT [ ) Depth .-.--i-------------- Diameter .---.... .—= Number ............................ Rock Filled s e Q `�/ ' ..... :�'*... hock Size ....... Yes No M ...._� Water.Tuble.:.Depth.._=.... Distance to nearest; Well .............Foundation --_-• Prop. Line -_____..___.-..... •� REPAIR/ADDITION(Prev. Sanitation'Permit# --••----•--•-• Date ..................... ...... Septic Tank (Specify Requirements)_.............. - '�........-------.................. .....................•-------------.-------------------------.....•........... Disposal Field (Specify Requirements} --------------• - ---D./�-•-,�� Nr`l 3 r .. ............... fi -------------------------------I--------------_ -----------_----- - . � -- - ........... - P -- - .�- ,4 (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and thdt 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: { f' sfi "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 ---__......................... .... ..- ----- ....r.---------- Owner �... :.... Title ._CQ.. .�_ /__l?.............. ............. By :.. .. (If other than owner ( ,- "' FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY ..----_._:.. ..... ................................:............................. DATE ...7 ��_ .�........... C BUILDING PERMIT ISSUED................ ............. .............•......•--••----•---•-... DATE :_..... ADDITIONAL COMMENTS......... :....... .........................................__..... :.....__... I = .............................. •--....-._..--•....-----••. --•------ ... . ` Final Inspection by: Date SAN JOAQUIN LOCAL HEALTH DISTRICT S ' 7/72 3 M F u 13 24 1_'An a.., sin