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OFFICE USE: APPLICATION FOR SANITATION PERMIT .,-," Permit No: . (Complete in Triplicate) ----------------------------------------------- Date Issued __ ------ Application '- ' __.______________ 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._ . _�--�� t .�> �,- �W_1_6/�r CENSUS TRACT ----Sq. Owner's Name -.r zso%_ ---------------------- ----- - --- ---Phone - '1(24 3° I4 Address ------ W-2.------------ ---------------------------------------------------------------------. City ---lfiNM1s16� Contractor's Name -- - -%----------------- ---------------- ---------------------License # ---------.----- Phone - Installation will serve: Residence [] Apartment House'Ll Corhmdreial ❑Trailer Court ❑ c Y _ : I t'Motel 3j%Otl7er _71"INIAP,�----------------------- Number of living units:.__------- Number of bedrooms ------------Garbage.GrindeiJ6___.- Lot Sizel' -__hZr'�S_______________ Water Supply: Public System and name ---------------------------------- '"-----------------"'r =___-:__Private ---------------•----------- - Character of soil to a depth of 3 feet: Sand'E] Silto Clay Peat❑\ Sandy Loam -❑ Clay foam ❑ Hardpan ❑ Adobe ❑ Fill Material _130----'If yes, type ---------------------------- (Plot ----______________-(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 'f [ ] SEPTIC TANK [ ] rp Size x ---- ------- Liquid Depth -- = Q Capacity ! �____-_--_ Type 1_�._ - Material_Q% No. Compartments p -- .._...__ 1 r � � Distance to nearest: Well ___.5007' - -----------------Foundation __�S_-----_------_ Prop. Line ___-- LEACHING LINE [ ] No. of Lines -------D f ---------------- Length of each fine--------�-Ob----_ -- Total Length :----�,bt�---__-_-___--- ' 'D' Box _� _._ T ype Filter Material -.Depth Filter Material _--,_- j_______________________________ Distance to nearest: Well __ (a '*____ Foundation _-1.6_ ___________ _ Property Line _6_ ._ r r [ ] Depth --�.l� ___------- Diameter -- - --�-- Number .-------V------------------ Rock Filled Yes No Water Table Depth t� r i --------------Z------------------------- u Rock Size -- �^- - II Distance to nearest: Well _____�71 _` ---------------------Foundation _ �_�_____- Prop. Line _!�a____---_ REPAIR/ADDITION(Prev. Sanitation Permit# -•-------------------------x---------------- Date ------ ------------------- 1 - Septic Tank (Specify Requirements) ----_________________-___._ :i - ------ Disposal Field (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 accordancewifh 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 rt-he work for which this permit is issued, II shall not employ any person in such manner as to b me subject to Workman's,Compensati.on laws of California." Signed --------------�.. �+ . Owner- wnerBBy Y -----------------------' --------------- ------------- Title: -------------------------- other than owner) - ` iFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------------------- DATE �� f BUILDING PERMIT ISSUED__ -_ ---_- ------:----DATE ------------------------ ------------------- TIONAL COMMENTS ------------- _146- ___________ __ '�.'t6__71 _- - - -. r. _ FinalIns ec b ------------ ---------------- ------------------ pY ------------------------ - - -- -- -- �------- �� ------ Date ' SAN JOAQUIN LOCAL HEALTH DISTRICT ____1H. 9 1-'68 Rev. 5M ':`0 )