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FOR OFFICE USE: '-APPLCATION t°FOR SANITATION PERMIT Permit No: ! --------------------- ------------- ---- (Complete in Triplicate) - Date Issued This Permit Expires >E 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 I described. This application; is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �-vovf,477----------------------------------------CENSUS TRACT -------------- ------- JOB ADDRESS/LOCATION�.-__�C&__�1-.--G+- ! Owner's Name Phone Cit �L�P < / lf Address zfWoeZ ',� �1�?°Q�� Y /C� f Contractor's Name -------.License phone ��_�_s i Installation will serve: Residence ❑ Apartment House,❑ Commercial ❑Trailer Cat Motel ❑Other -------------------------------------------- / a�. €-5 ' F Number of living un�ts:_.L_______ Number of bedrooms __________Garbage Grinder _______.____ Lot Size ------------ __�- Water Supply: Public System and name ----------------------- ---------------------------------------------------Private f Character of soil to a deptk 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 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,) r� PACKAGE TREATMENT { ] SEPTIC TANK [ ] n Size----- ------------------------ Liquid Depth - - -------- "1 Capacity _1� ------ Type Pr��, sYMaterial-- No. Compartments ---- -r-=-•-- # , r Distance to nearest: Well ------- G�- ------__ ______Foundation ---f0_ __--____ Prop. Line __.-__-_____.. LEACHING LINE [ ] No. of Lines ___.___ ___.-- ----- Length of e�rch Ie�.,__ -------------- Total length ----10-0 Box .- Type Filter Material ZX____�__Depth Filter Material ______ _ ________________________________ r ,,ms�ss Distance to nearest: Well ------------------------- Foundation ___/lam----_____---- Property Line ---�~ ----.--- -- SEEPAGE PIT [ ] Depth __�..-------- Diameter _ ----- Number ._-:-----�___________ ___ Roc filled Yes No 1❑ Water Table Depth --------6_ i—--------------------------Rock Size :P e f�1-�----- � Distance to nearest: Well ____-��---------------------- Foundation ,/Ca__- ---- Prop. Line ----J .......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------] Septic Tank (Specify Requirements) ----------------- - ------------------------------------..---------------------------- 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 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 x as to beco iect to Work man's Lompen tion laws of California." Signed #-J er r Title --------------- - ------------------------------ - - -------------------- (If other than -)FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - ------ --------------------------------------------- ------------------- DATE --•------------------- BUILDING PERMIT ISSUED DATE / ADDITIONAL COMMENT �r- -/�Td��✓------5) - - ------------------------------ - -- - --------------------------------- ----- -------------------------------------------------------------------------- -----------------------L Final Inspection by: ------ -------.Date j "' --=7-Y------ ---- N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 R . 5M