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FOR OFFICE USE: " APPLICATION FOR SANITATION PERMIT -------- -------------------- --------- Permit No. (Comp lete in Triplicate) --- --------------------------------------------�=--- r� Date Issued � ............7SC ' -. 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 _ ------ '__"M.�' �.� ;7-62-- J ' � ' �� =CENSUS-TRACT -------- ------ 1 ,/ �» . Owner's Name --=---��L1lG_(rC.:��------��-��'�-�-�-�'---------------------- ------ -------------Phone J � - ='� `-��--------- -------------------License # T � a:_. Phone �-----��----� Address -------- �_o-----,� ..... '=-w _6 �.- 7-----------------------------•-- Y = Contractor's Name _----- .x_ r ,�=t�l--- -- � g I Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court ',❑ + Motel ❑Other _ Number of livin units:---- __- Number of bedrooms -----Garbage Grinder ------------ Lot Size ----� ----r,��.---=------- ` i t :. Water Supply: Public System and name ------------- ------------------•-------- ----------- ---------------------•-- -------------------------______Private ❑ Character of soil�6 a depth of 3 feet: Sand'[:] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe-❑ Fill Material ------------ If yes, type _________.__-:__------------- (Plot plan, showing size of Tot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septiAankorseepage pit permitted if public sewer is available within 200 feet,) Z 111 t"- / _.WPACKAGE TREATMENT [ ] 'SEPTIC TANK'[ ] } Size__Z� _?f �l% s�_____-_______ Liquid Depth __________________________ J Capacity ------------ Type n-eV41 6/�'"Material---------------------- No. Compartments --------------------- j I Distance to nearest: Well - 1----------------------------Foundation __ t1------------- Prop. Line .-%�- = :----- .�t I t LEACHING LINE � [ ] No. of Lines ;_ _�"._____ ___°____ Length of each line____-�_________.__ "- Total Length _-__Z5- ........ i 'D' BoxF._:__/_`_--- TypF tar MateriaM114/7 Depth Filter Material ____If_�_____.___t____ I t ` f Distance to ,nearest:rWel.l,, -----""-" --- Foundation -Z-1)------------- Property Line ___ _____;_._.____.__. i�l SEEPAGE PIT' [ ] Depth illy-er- lar-eter ________________ Number ______.._________-----_____ Rock Filled Yes No I❑ .� ' Water ;ablb`Deptfit:-------- -------------------------------------Rock Size ---------------------------- t. Distance toearest:',WelNtK------------ ------------------------Foundation -------------------- Prop. Line --------_------------ t t; ,,,;r:g tb REPAIR/ADDITION(Prev. San itation-Perrhit-#�_--.--------- ------------------------- Dat ; �----- -} re --------------------------------------- ------------ Septic Tank (Specify�Requirements)-_______________ i t Disposal Field (Specify Requirements) -------------------------- ----•------------------------=--------------- ------------------------- ------------------ ----------- I .: ----------- ------------------------------------------ --------------- ----------------------- -------- -----------------------------------------------------..-..--------- - t (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,rState Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 3 "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 subje t t- Workman'p.s Compensation laws of California." i rc ------ OwnerSigned -------- By ' ------------------------ Title - ------------- If other than ow6e01 j 01 FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. "' -------------------------------------- --------- DATE - 7_./ =-7/`-- ------------- BUILDING PERMIT ;ISSUED ---t --------"--- ------ ----------------------------------------•---------- ------ DATE -------= ADDITIONAL COMMENTS ----- ------- -__-_ } - ----=- ------------------- --------------------------------------------------------------------------------------------------- ----------------- - 9-------------�------- ----- ----------------------------- -------------------- --�- --- --------------------- ---- FinalInspection by: ----------------------------------- - -- -------------- ----- ------------------------------------------------------Date -- ---------------- ------ ---- ---- ISAN JOAQUI LOCAL HEALTH DISTRICT t E. H. 9 1--'68 Rev. 5M