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FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT yd__�- Permit No. _7 :............ (Complete in Triplicate) ----------- Date Issued ______-________,'______.____. �_______---___ 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 ------- p -- ---- ENSUS TRACT ----------------------__9__ _U____ �_____ __ p--��[ '_�G % ^C Owner's Name �'�G ' ��GG__ - ` ��" Phone - Address ----- 67-- 7-------) ------- F ---"C---��1 -1 City - Contractor's Name _____ 2G-- .,._________--� ___ _ __ _ ,/ ►y *- -.____.License #o ff _ � '.l-�I-- Phone _46K;�?_r ./ Installation will serve: Residence `Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:__-____ Number of bedrooms _-o ------Garbage Grinder.��___ Lot Size .................... WaterWater Supply: Public System and name _____�* w- _____.� _. '� ------------------------------------------ ---------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ 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,) PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] 1—'X fS '*`Si e_G_______________________________________ Liquid Depth --------------------------- Capacity _______-_____-_____Capacity -------------------- Type -------------------- Material-------------------- No. Compartments ...................... �(f Distance to nearest: Well ____________________________________Foundation _____________________. Prop. Line ...................... LEACHING LINE j�` No. of Lines ------1-_ ___________ Length of each line-_____�� Total Length ,___l�lQ.�.__.______ D° Box ,____ ______ Type Filter Material __/0Q ---Depth Filter Material ___�_J _�_�----------------- -- Distance to nearest: Well ----£S0__�______ Foundation __f�"_ _________ Property Line ....... ............ SEEPAGE PIT i Depth _ _�______ Diameter �7�_f� Number ______/-_______________- Rock Filled Yes No i❑ Water Table Depth -----------94 --- _______________________Rock Size _____-�-Z__-- -__-________-___ Distance to nearest: Well ____ _______________Foundation _____ F---- Prop. Line ...... .......... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ________----.-------___-________-- , Septic Tank (Specify Requirements) ---------------- - / ------------------------- ------------------- ----------------- --------,..--------'------ Disposal Field (Specify Requirements) ------- c° _4 r._ ______ --____ =----f ----- - --------- ------------------------------------------------------------: ----------- --------: ------------ ------------------------------------------ ------------------------------------------- --------------------------------------------------- ----- -- ------------------------------------------------------------------------ (Draw existing and required addition on reverse side) 1 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 .....c - .' ----- Title -------- ----------- - - (If other than o=ne- r)) R DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY ------- ---- - ------------------ DATE -----1 l-G- ' -------------- BUILDING PERMIT ISSUED -------- -- - ---- -- -- -- ------------------------------------------------------------- -----DATE ---------------------- -------------- ADDITIONALCOMMENTS -------__ -- -- -- ----------------------- ?L-::------------------ ------------------------------------------------------------------------------- ------------------------------------------------ - - ------ ...... 1-------7_�-------------- -- ----------------------------------- --------- -------- -------------------------------------------- - - ------------------------------------------------- - -"7z---------------------------- ------------------------------------------ - - --- - - -- --- -- - --------------------------------------------------------------------------------------------I-------------------------------------- Final Inspection by: ------- - - -- - -- ------- ------------------------------Date -- -------•------- SA JOAQUIN LOCAL HEALTH DISTRICT a E. H. 9 1-'68 Re . 5M