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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- ------------ -------------- -- (Complete in Triplicate) Permit No. ----------'- --------- -------- ---------- This Permit Expires 1 Year From Date Issued Date Issued -------------- U 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�cor�pliagce w. h Coy y OrdW' rye No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT l -�3----� b �ylJ r � _%NSUS TRACT -------------------------- Owner's Name --------�.LRl4 ---------------------------------------------------------Phone ------------ ----- --- -- ----------------------------------- ----------------------- Address -------------------------- ��-------��---- /�----�--,-- -----•--- --- City __vl� ------------------------------------------------1----------- Contractor's Name ----- Installation '^�`- ----- ` •c ` """ -�""-""`"` ----License # _1 �_ 7r Phone ----------------------- - ---.... Installation will serve: Residence. ?[Apartment House-0 Commercial :❑Trailer Court io Motel ❑Other ----- ---------- ----------------------- - Number of living units:------- --- Number of bedrooms _______Garbage Grinder _.__' -_ Lot Size __________________________________________ Water Supply: Public System and name -------.------------------ ?7�' !L �� -=-_= -----------------------Private ❑ Character of soil to a depth of 3 feet: Sand;❑ Silt'❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam D Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ________________________-___ (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 [.� SEPTIC TANK:11f _ Size_-_'_l _ '�a____I __ `________________ Liquid Depth ------------- Capacity__/�,'0_c;_,7a Type -------- No. Compartments _2--.......::.... Distance to nearest: Well ------/c -----------------------Foundation --------)_d�_'_______ Prop. Line ---!'`-------------- YJ LEACHING LINE [ J� No. of Lines g �_____._____ Len th of each line_______._7d - --___ Total Length l _ ________________ 'D' Box .-J------- Type Filter Material ___ _ ________Depth Filter Material ----- `_`^______________________________ 4 Distance to nearest: Well ------1__�n__-__---- Foundation -----.__1 Q_ ---- Property Line ----____---__------------- �� I SEEPAGE PIT [K Depth ...... 0--------- Diameter __ ______------_ Number ___,___Q?-_________________ Rock Filled Yes [�' No i❑ , Water Table Depth '3�' -------------------- Rock Size F� ��- ------ Distance to nearest: Well __________J ---------_.......Foundation __1a_------------- Prop. Line ---$-_----------- p REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------ ------------------- Date ---------------------.------------) 0 SepticTank (Specify Requirements) -------------------------------------------- ---------------------------------------------------------._------------------------ - - r . Disposal Field (Specify Requirements) ------------- - - ------------------------------------------------------------- iy ------------------------------------------------------------------------------- _ ___________________________________________----______---_________________________--___-___-______._______-__________________---________- (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 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." Signed -------------------------- ---------------- Owner By ------------------------------------------ - - ----------------`6 Title _ - - - -- --------------- (lf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY iz ------------------------------------------------------ ------ -- - DATE -----?-7�1/"-7-3---------------- BUILDINGPERMIT ISSUED -------- ---------------- ----------------------------------------------------------------=--------------DATE ------ ------ ----------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------ ---------------------------------------- --------------------------- ti ---------------------------------------------- ----- ---------- ------------------------------------------------------------------------------------------------------------------- ----- _ -1 -- p Final Inspection by: ------- - -------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M qA