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FOR OFFICE USE: --------- -� , -fid,a ----- APPLICATION FOR SANITATION PERMIT t - (Complete in Triplicate) Permit No. _gW-- 6 -------- ----- a 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 iss� made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-.�J_7:----7-51- P V Jy] -- --- -------------- TRACT Owner's Name MU- /-6 l -41--------j-o- C-- ----------------71, � Ph ne Address -- ,,• City /�G r? �/ Contractor's Name - ------ ___. ,� -� -- ....................... _: �' ------.License # -/7 -tI_! . Phone Installation will serve: Residence 6 � Apartment House❑ Commercial❑Trailer Court '❑ Motel ❑Other t - - - - ---- -- Number of living units:---- ----- Number of bedrooms Garbage Grinder ?70___-- Lot Size Water Supply: Public System and name _ _ _ ----------------------------- Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ----- ------ If yes, type !------------------- (Plot-plan, showing.size-of-lot, location.of•system, in relation -ta-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,) f PACKAGE TREATMENT [ ] SEPTIC TANKSi � ' ] ze --------------- ------------ LiquidDepth ------- rCapacity -------------------- Type -------------------- MaterialNo. Compartments __ _ -----•-------. Distance to nearest: Well ------------------------------------Foundation - -------------r-------.Prop. Line -------------:-_------ LEACHING LINE '� [ ] No, of Lines ------------------------ Length of each line-------- -------------- Total Length Box ------ Type Filter Material --------------------Depth Filter Material _ _ _ ----------------- ---------•- Distance4o nearest: Well _____________________-- Foundation'*W Diameter ------------- Property Line - SEEPAGE PIT ---------------•-••- -�_ [ l Depth ----------------- Diameter Number Rock Filled Yes ❑ No Water Table Depth ---------------------- ....,_. _ -Rock Size i Distance to.nearest: Well -----------------------------------------Foundation F RProp. Line ------------------ REPAIR/ADDITION[Prev. Sanitation Permit# _________ ______ ------------------- ------Qcite ------------------- -------------1 Septic'Tank.(Specify Requirements) -------------------------------------- IV , V ------------------ Disposal IF- ------------ -- ------- �ld (Specify Requirements --------------0,_---__ � l J---------- -- = E l ----------- --- - - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- E i (Draw existing and required addition on reverse side) A I hereby certify that,l.have prepared this applications and'that.„the work will be done in accordance with Son Joaquin Couniy Ordinances, State Laws, and Rules and R gulations 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 whichpermit is issued, I shall not ern to an as to become subject to Workman's Compensation laws of California." P Y Y person. in such manner Signed -------------4 „t ------ ----- ----------- '4 � � - ----ri--�-- - - ser By ---- ---- - ------ - Title - fx - ui - [ f other than owner) -------------------- ---------- -- �FORL�DEP�AIRTMENT USE ONLY APPLICATION-ACCEPTEb-BY .- {_ BUILDING PERMIT ISSUED -` -------- I --------------------------------------------------------- DATE -------- � ------------------------ ADDITIONALCOMMENTS ._R------ ---- - ----------- ------------------------------DATE ----------------- s r ---------------------------------------------------------------------------------------- --------------------------------------- _ ---------------------------------------------------------------------------------------------------------------- -- - --- -------------------------------- -- - ------- --- -' ---- ----- ----- Final Inspection by: _ _, -- - -- --------- = - -- ------- =------------- ------------------------ --- ------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M e "-