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FOR OFFICE USE: + APPLICATION FOR SANITATION PERMIT ---- �f ---- -�-------------------- r �c )Complete in Triplicate) Permit No. Date ----------------------- -_______ ---..___ ---------------------- 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 `pde in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �,/ 1�_ l� j__ e,AfJ<.____*IS"____-57ZFrX t2__r �JkNSUS TRACT _-_;-6__..___....___ Owner's Name . -------------- --------- hone ------------------------------------ 1 Address --------�L7407/0-[/----- - - city Contractor's Name -----------------------------------License #,fs - Phone " - � Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ------------------------- ----------------- Number of living units:___ -___ Number of bedrooms _ __-_Garbage Grinder e Lot Size _`-QAe�_______________________ Water Supply: Public System and name ------------------------------------•------------------------•------------------------------------------------Private$ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-4 Fill Material ------------ If yes,type - _______________ i (Plot plan, showing size of lot, location of system in relation to wells, buildings,;`etc. must be +placed on reverse side.) v NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK Size ------------------------- Liquid Depth ___._____.___ rti Capacity/ _ Type -__ Material_dJV7d.-1---- No. Comlpartments _-_-%: ............ Distance to nearest: Well ------ �_____________________Foundation _,el________-�,eprop. line __,___ __:_.._____ LEACHING LINE (� No. of Lines -___,�*___--______ Length of each line _ _ Total 9th ,/� � D' Box$/,�_r� Type Filter Material aDepth Fitter Material Distance to nearest: Well -_Ce-------_-_-__ Foundation _/ _-�_-_. . _``prooerty Line �__-.r_ ........... SEEPAGE PIT [ Depth ___9 /-__ Diameter - �r-_ Number ____ ;_-__ Rocl Filled Yes ° No 0 ---- --- .,+ Water Table Depth -__--45�40__ ____________________________Rock Size Distance to nearest: Well -__f� _______________________Foundation ----- Prop. Line - ................ REPAIR/ADDITION(Prev. Sanitation Permit# __-__-_ ------------------------------------ Date __--__-_-__-_-_-- .___-_______Y) Septic Tank (Specify Requirements) ----------- ------------------------------------------------------------------------ ---------- Disposal Field (Specify Requirements) ----------------------------- - - - ------- - ----- --- -- ------------------------- ------ s --------------------------- ------------- *'-----------------------------------------------------------------------------------------k=-'----------------------------------- (Draw°existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in ac nce with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,Di tCic. Home owner op`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 emplo y person in such manner as to become subject to Workman's Compen ton laws of California." Signed Owner BY - -------------------------- r - 4'4` ------ --- TiAe ------ - ----- - --------- -- -- ----------- ------- (If o,?than owners pf E T ENT USE ONLY ,Iy /�j APPLICATION ACCEPTED BY -------- Ae -------- ----------------- DATE rl = / 7---------------- BUILDING PERMIT ISSUED ------- - ------ - I- ------------------------------- DATE ------------------------------------------- ADDITIONAL COMMENTS _---- __-___ r 1 I---t---------- -------------------------------- ------f-1 _______________________________ ______-__-_ __ -_ --_- _- _ .}-----1f___ _________________________________________ _ FinalInspection by: ---- - -: -- -------- -------------------- --------- ----------------------------------Date --------------------- N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Zev. 1h =