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FOR OFFICE USE: y Z to rb PLLCATION FOR SANITATION PER* (Complete in Triplicate) Permit No: ----------------------------------------- This Permit Expires 1 Year From Date Issued 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 ._-- ----Q. --------- -`-- _ % ---_5• -- /t�_CENSUS TRACT --------------I........... Owner's Name ---------- -------------------------------------------- -------------------Phone � ``-- Address ----- ----------- -477�;-�- ------------- -------_ City --`7`0 '- rtl't/----------------------------- Contractor% Name -_ ------ ----- --- ----- �— --- - -----_---------------------------License#e�� t A�-_. Phone Installation will serve: Residence WApartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- r Number of living units:--/----- Number of bedrooms ._v-Z----Garbage Grinderelt/ ___ Lot Size ___-----___ Water Supply: Public System and name ---------- � ------19V� --------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe,[V 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 [ ] SEPTICTANK:[ ]frfsf''"fg' -------------------------------_____------------ quid Depth __.___.________-_--_ Capacity ----------- ------ Type --------_--------- Material--------- ----------- No. Compartments .-•------------------- c10 Distance to nearest: Well __________________________________Foundation ---------------------- Prop. Line --- .................. UJ LEACHINCx LINE [ j No. of Lines --------- -------------- Length of each line-------------------------- Total Length ............................. 'D' Box ------------ Type Filter Material ___________________Depth Filter Material -------------------- Distance to nearest: Well _______________________ Foundation ------------------------ Property Line ........................ i SEEPAGE PIT j' Depth __-a ---______ Diameter �-----3______ Number _-__-_o ___________`_ Rock Filled Yes ( No 0 Water Table Depth --------9er Rock Size .Distance to nearest: Well _. U____W_ '�___,----Foundation __, ___.____ Prop. Line .-__.�.......... REPAIR/ADDITION(Prey; a.Sanitation.Permit# --------------- __ - ----------------------- - Date ----------------------------------) . Septic Tank (Specify Requirements) - ------.-------- ______--- _____________________.._ - ------------ 977; Disposal Field (Specify Requirements) __._!�s!_s/z-- c-------- _____ f_ '______ ___/1 ►"'e:____1 - '•4- - r --- --------------Zeoeell----- 'e. -�f------,ve7..------ . ' . f'e-z_4,_1--a--------------t'W_`e-------�ZIC, e4esr 14 j` ' 4�YQ/Y e 5'f � a—ka...--...... PP_l,t'_e�r�s s (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 -------- _ - ------------------------ Title (If other than owner) FD r ENT USE ONLY APPLICATION ACCEPTED BY ----- -------- - - --- ----- - - ------- ----- -------------------------. DATE -----��-1 -------)---------- BUILDING PERMIT ISSUED --------- -------------------------------- --------------DATE ------------- ----------------------------- ADDITIONAL CO NTS --- -- - -- ------- - 11 f _ �1rir" �`�t o - 4_( ?Ct4 :�—v ^fi -yrrz�d 'r r 91 0 10 ----------------------- ---------------------------------------------' ------ ---- - ---- - ---------------- - --------------------------------------------------------- ------------------ Final Inspection b Date __-__.__ T J �! GAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M l"/