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FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT ------------ ------------------------------ - ` 7_2--__4.0..C.. (Complete in Triplicate) Permit No. _ J{ Date Issued ,_Z_:_?_z ------------------- ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San oaquin 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 JY _ 4,_ , ��,%,;_4�//:F1ENSUS TRACT _J�®_� ------ Owner's Name __1"'- li /`� '�° '--------------- ----------------------------- ------------------Phone --------------------------- -------- AddresseDom-- — ----------- �-------------------------------------------- City --- r��D.h�7-- - f _ Contractor's Name __ --------License # 4rf-67-3____ Phone Installation will serve: ResidenceA Apartment House❑ Commercial :❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:---/----- Number of bedrooms _S-----Garbage Grinder __________ Lot Size _______________ 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 [ Fill Material __ __ If yes, type----.------------------------- (Plot __._:__ __ _ -__ (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc. must be placed on reverse side.) (� NEW INSTALLATION: (No septic tank or see ge pit per if public sewer is available within 200 feet,) �1 PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size------q_:X__s------------_------------ Liquid Depth _ ............ l •., .� . C acit / �:_,__ T � .! ______ Material_ __.__.. ' P Y - - - Yp - --- �- -C�-�.7-`No. Compartments. ___�_. Distance to nearest: Well ------ -VC-- _._gip__________ Prop. Line ___ ._.._.__ LEACHING LINE [ No. of Lines ___, -__________ Length of each line--------- ---__-____ Total Length ............. 'D' Box 644-__ Type Filter Material AA_ ._.Depth Filter Material -----AP .......................... Distance to nearest: Well -_--��---_----- Foundation /to------------ Property Line` _��_!._---_- l SEEPAGE PIT [ Depth ____,� -------- Dia�+e4er _X _____ Number ______�-_____________ Rock Filled `=Yes No ❑ Awl `' Water Table Depth ------ -----------_-----------------,_----Rock Size Distance to nearest: Well ------/LIQ_----------------t.....Foundation ---------- Prop. Line ...................... r REPAIR/ADDITION(Prev. Sanitation Permit# _______________ ______________ __ Date ----------_:.___--____________-_) i Septic Tank (Specify Requirements) ---------------- ` Disposal Field (Specify Requirements) -------------------------•-•-----------------'------------I---------------- ---------------------------------------------•----------- y. (Draw existing`and`required additi'on'ori`reverse�side) - ,-".. 1' _.-- _ . I hereby certify that I have prepared this application and that jhe 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 beco t��subject to Workman's Compensation laws of California." t. Signed ----- ---- ------ Owner BY -------- -------------- -=-- - ------- Title ----------------------------------------------- ----------------------- (If of er t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- 0--------------------------------------------------------------------- DATEi��----- BUILDING PERMIT ISSUED - ------------------------------------------------ - DATE - ADDITIONAL COMMENTS -- -------- - --- --- -- -- --------------------------------------------------- ------ ----------r � _- O- - ------------------------------------------------------------------ ------------------------------ - -------- ------------------------- -------- ------- --------------------------------------------------------- ----------- - -Z - :/V--- -- - - Final Inspecto � _Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M _