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FOR OFFICE USE: --- ----- APPLACATION FOR SANITATION PERMIT ------------ --------------------------- (Complete in Triplicate) Permit No. ---- This Permit Expires i Year From Date Issued Date Issued pplicotion is herebyq described. This application eis made in complin Loc l He lth District for a No'.' ` permit to construct and instal) the work herein IOB ADDRESS/LOCATION . {p 549 and existing Rules and Regulations: Owner's Name --_-__"--- = .---------CENSUS TRACT . Address --------- -------- -- ------ . r f �� i; _ Phone 346e—. �(}-j1 Contractor's Name ___-___ Cit Installation will serve: ----_-�----------- ----W ------ - --- ---- ---- -----------License ��W Residence � `-� -� #��--- -- Phane -- =�--"_-.-- -- Partment House Q Commercial ❑Trcfiler Court i❑ Motel El Other-__-______ Number of living units: -- ---- Number of bedrooms - Water Supply: � Garbage Grinde Lot Size PP Y: Public System and name ---------_ Character of soil to a depth of 3 feet: Sand' --•------------------Private ❑ Q S"t.Q CJay_Q, Peat Hard an ❑- Sandy Loam '❑ Clay Loam ❑ P ❑ Adobe �' Fill Material _-___-_____ If es _______ Y , type (Plot pian, showing size of lot, location of system in relation to wells;.buildings, -etc. must b NEIN INSTALLATION: {No septic tank or seepage p e placed on reverse side.} ` PACKAGE TREATMENT pit ermined if public sewer is available within 200 feet,) � 7 SEP i IC TANK�[ ) t� I Capacity Liquid Depth - ------ -1 p Y ------------ Type --------------- -`: Material------" `` Distance to nearest: Well _ 77n- `No. Compartments -------- ----------- _----.__-_ D LEACHING LINE _.Fouridati ---------------------- Prop. Line ------------ t ) No. of Lines �"h `° Length of-each line_ ' = Total Length --•- D' Box ------------ T Type Fitter Material_____ ___ Depth Filter Material - Distance to nearest: Well ---- ?- ------------ ----------------------------------- Foundation ----------- --- SEEPAGE PIT � ----- Property Line ------------•------_---- ( ] Depth ------------------- Diameter ---- Number _ . ---" --" Rock Filled Yes 0 No iQ ------------------------- Water Table Depth --_-_-_____ t ��"�`-""�""'""�"'�' ------------------------•--------•---Rock Size ----�----- '-------- -------- -- Distance to nearest: Well -------' `___-_ _ __.__Foundation i ------ Prop. Line .---------- REPAIR/ADDITION(Prev. Sanitation Permit+ ----____ - E r ' ---------------- --- Date l ` Septic Tank (Specify Requirements) f----.--.-- Y-____.-___ - isposal Field (Specify Requirements), "--: .4. xCzs - -------------------------------------------------------------- - ----------------------------- -------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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"'-. r Signed ------------------------------ -------- Owner By --------------- --elclJ W"v - - - - --------------------------------------- Title.-- ---- - - --j � (If other t n owner) FOR ARTME_NT_'USE ONLY APPLICATION ACCEPTED BY _______ ___ ___ _ _ I ' BUILDING PERMIT ISSUED ------ DATE _.,�`___.-_ ADDITIONAL COMMEN - --- - -- - -- - ----- - - ----=-- - ----- ------- ----- --- DATE ----------- ---------- -. - - - -- ------- - - ------- - ------ -------- -/G 7 --------------------------------------------------------------- -- ------ - -- - - ------------ -- -- --- -------- - - ----------------- --------- --------------------- - - - ------------------------------------------- --------------------------------------------------- � Final Ins ectiowb - ---------------------- -------------------------------------------------------------------------------------------- ------------�------- � - -- ------------------------------------------ - ------ -------- --------- ---,Date -.. IV JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M`