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FOR OFFICE USE: ;O APPLICATION FOR SANITATION PERMIT -- ----------------- ----------- .. Permit No: .7.Z-1c)../ `(Compllote in Triplicate) -------------------- -- ____.______________________________________________ _ 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: r JOB ADDRESS/LOCATION .--- ."_`-. ------- J1-o---------------------_-----CENSUS TRACT "---=---------------------- Owner's Name ---; / •------------- --- -•--------- - --- - ------ ...........--- --•- ----•----......----- Address ------- .?47,0 ;,e--------------------------------------------------------- ............... City . �Pjele.1eI7------- --------•-------- Contractor's Name r----- -------= --- -License # ✓�� Phone _... Installation will serve: Residence$Apartment House❑ C000mercial ❑Trailer Court !❑ Motel ❑Other -------------------------------------------- log Number of living units:---l..... Number of bedrooms,,;? _._-garbage Grinder d __ Lot Size,/% ._- ............ Water Supply: Public System and name _----------------------------—------------------------------ - ------------------ _Private' Character of soil to a depth of 3 feet.. Sand❑ Silt W Clay ❑ Peat❑ Sandy Loam C❑ Clay Loam;❑ Hardpan ❑ ;Adobe 0 Fill Material ------------ If yes,type............................ (Plot plan, showing size of lot, location of systjem 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 with[n 200 feet) PACKAGE TREATMENT [ ] SEPTIC TANK ----------- .. .Liquid Depth/ -_-------.•_---- S!J Capacity/�e ;;_ Typ�/�i� _ Material A4__a---- No. Compartments ;----_------------ or -_-- :------- (a Distance to nearest: Well •-_- C1. oe -___________________Foundati� 1�__� .____-• Prop. Line,�e ......-_ 01 LEACHING LINE (J No. df Lines ------ ----_______ Length of each `line---��- ------------ Total Length/.AO................ V Box Type Filter Material/��/., _41i _-Depth Filter Material.1149.................................... Distan a tc nearest: Well -_-,,e_e_ ......-__. Foundation 010V- --- _-Z fy�--------------- Property Line ,................ SEEPAGE PIT Depth -o ---__.__-_--_ Diameter � ...... Number -- :_____ _____________ Rock Filled-Yes, [ Noi❑ Water Table Depth _-__-_ `__...._ __________________Rock Size....-__ _`_ .c_ s Distance to nearest: Well _-AP149_______________________Foundation _ .-_..._-_'{'rop. Line .. ........... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____--.--_-____•---_---.� Septic,Tank (Specify Requirements) --------- ----- ----- -. ------ ,.•........................... Disposal Field (Specify Requirements) ---- !"' �.. ... �:..�. i-- - ------------------------------•---- -----' --------------'------------------------------------------------------------'-------------------------------'--------------------------.---.--------------•-------------------••----------•••-----•---•--- (Draw existingand required addition on reverse side) - - 1 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 WorkhMn's Compensation laws of California." Signed •---- ----------------- --- ----------------•-----•----- Owner . _. BY - - -----Mo f ------ Title ----------------------------- (I er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --=------------------------ DATE ,---------------- BUILDINGPERMIT ISSUED ------------------------------- ---------------------------------------------------------------------- DATE -------------•------------------------- ADDITIONALCOMMENTS -----------------------------------------------------------------------------------------------------------------------------------=-----••----•---•----------- // --�-- � � --c+-C. •gip Final Inspection by: --- --_--:._ �` -- Date . SAN JOAQUIN LOCAL HEAaH DISTRICT E. H. 9 1-'68 Rev. 5M e