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--� FOR OFFICE USE: APPLICATION FOR: SANITATION PERMIT �� /� ---------------- -;---------- _ __ t Permit,No. -= -- 4 .. a ] �,..,f [Complete in Triplicate] - `- ------------- Date issued --- " .... # This Permit Expires 1 Year From Date Issued -------------------- �_. ...� 7�4 F 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 complian'a with County Ordinance No. 549 and exisfiing Rules and Regulations. ; t f SUS TRACT ----- `------ -'*--- ; JOB ADDRESS/LOCATION . ---- 51 .5 'O -------F# ` - ' - ' A .. .�11f 11lt9' Cwt---------- - ne Owner's Name '� O~ (� --- ---- , Pho _A V.. Address ___'- ------ '' �- r te �� L City a�� Q ryc14 _ = �/ Contractor's Name _ fC l--(- 1 ----5 '4�( `� License # , Phone -`�- -- l ` Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court ;❑ Motel ❑Other 4-------------------------------------- _.� ` } Number of living units:_.____-- Number of be ____ "Garbage Grinder ------------ Lot�Sze __114-440-4-------•------- - Water Supply: Public System and name ----------------------------- -------------------- Private t $ �- " b. Character of soil to a depth of 3 feet: ,,;Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam r Clay Loam hlardpan-❑, Adobe' Fill Material ------------ If yes,type --------- ------------------ .�. �.A (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: i (No septic tank or seepage pit permitted.if public seweris-available within 200 feet,) v PACKAGE TREATMENT [ ] SEPTIC_ TANK'[ ] ''• •° 5ize_F-------------------------------------------- Liquid Depth ------------ ----- p g capacity Type Material ------ Nb. Compartments ----------- Distance -.---,• to nearest: ----------------- --Foundation Prop. Line :'- 1 Len th of'each�-line---------------". .--'--- Tota E Length LEACHING LINE [ ] No, of Lines _.__________________ __ g - D' Box -�---------- Type Filter Material ----�- -----:--DeP th, Filter Materia -------•- _ Foundation - Property Line ------------ •--�..--- ' Distance to nearest: Wel{ ________________ _ �• ,. CSEEPAGE PIT [ ] Depth -- __-- -- '=---- Diameter , } Number--------------------------- Rock Filled Yes ❑ No ❑ r -------- � Rock Size ------------------- r Water Tale#Dep#h _.._________ :------ �_--€aundat'ion------------------- Prop. Line --------------..... Distance to nearest: Well ___-____ v I ; I R ---------` ---�----s-°=-: Date ----------------------------------- REPAIR/ADDITION1 (Pre'v. Sanitation Permit# ;-- t t � ` Septic Tank (Specify Requirements - - --- --h _ ----------- Disposal Field (Specify Requirements) _ rt > '7 ---------------------------------------•------- -r r-----------i- : . . -- --------- ------------------------- (Draw existing and required addition ---------- -------------------------- --------------------------- -------- = dition on reverse side) I hereby certify that I have prepared this application and that a 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'lows'of California." I ' Owner �:o g „a- - -------- - SI n �(If __---_ - r' Title -- ` ----------------------- ------------- r than ownerl t _ FOR DEPARTMENT USE ONLY � � APPLICATION ACCEPTED BY T --------- ' _1r` -------- _ DATE _ " 3 - PERMIT ISSUED ---------------------------------------` ! ---------- ------- BUILDING DATE a ' i ADDITIONAL COMMENTS-----------�--------------- --= - •--------- ---------_:----------- ------- ----------------------------------- - -{ --- ` ---- ------------------ ----------------------------------=------------------------------------- ------------ --------------------------------- ------------------------------ - ------- - . --- t___ ------- -- - -- --------------------- - ------Da - - -- Final Inspection b t_____-�_!2i•• _ 4 l '- -"-- ”" .................................... ----- - --" - I I USAN_�JO'AQUiN LOCAL HE LTHy DISTRICT,„'- , I E. H. 9 3-'68 Rev. 5M '