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FOR OFFICE USE: ! �•3v APPtfCAT10,N FOR SANITATION PERMIT ��/ a - �rt~�°----��------/='-- ----------- ------ � C� Permit No: -------------------- (Complete-ih Triplicate) - - -------ADO-—:------- ----- 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 Ithe work herein described. This application is made in compliance with County Or inance No. 549 and existing Rules and Regulations. Q / F -_CENSUS TRACT _____ .JOB ADDRESS/LOCATION �--/----� �----�•�!� -��°� --�--- ------------- ,�------ ' Owner's Name ,- ?------ i ,/ - --- �-_�--- - Phone - Cit o�7'-! 6�l Address --�-,-� �----�1��-- �-��----------- ---------------------�--• f'- � Phon----- ----------•-------------- Contractor's Name -- Lice1se ;N : �, -- Installation will serve: Residence Apartmrent H use ] Commercial ❑Ttailer Court C]- Motel ❑ Other ----------------- --------------------- J i . / Number of living units:_______ Number of bedrooms __ --Garbage Grinder Lot SizeNri0__X!/240------------ i Water Supply: Public System and name ._ '� � �s'}lam'_!_ - sf/=y''-r-� !� :-- - i��---`_`--•---------private ❑ ; Clay Peat ❑ Sand Loam 'Clay, Loam- Character of soil to a depth of 3 feet: Sand'❑ SiltE❑ y ❑ � Y ❑ Y ❑ Hardpan ❑ Adobe Fill Material-----------S,f rtes, type ---------`----------- -- .- ' (Plot plan, showing size of lot, location of system in relation !to wells, buildings, -etc. must be `p'laced on'reverse side.) NEW INSTALLATION:----(No septic--tank or seepage pit pe rnitted if public seWer is available within 200 feet,, PACKAGE TREATMENT [ ]' SEPTIC TANK'{ 1 Size --------------------------- --------- Liquid tbep#h _ ----------------.-••-- 1 , r € Capacity ---I--- --------- Type ----------------�-'Material No. C partments ------ - ----- Jr ---------------- o al Len th .- -------- ----- Distance to nearest: Well______ _ _ _____ ___ 0 _ -----------Foundation ---__._____- LEACHiNG LIN [ ]� No. of Lines ___.________________ - Length of eachy line_._,_____ �� ,., D�Box ____ ____ Type Filter Material ____�_ y..........Depth Filter Material _ __ — - _----------.- ` '_� - r. Distanceo �earest: Well ------------------------ Foundation ------------------------ Property Line --_- f - SEEPAGE PIT [ ] Depth ------- i----------- Diameter NumbeRock Size ---�'---_---- Rack Fill d Yes ❑ No .0 Water Table Depth ----- --- t Distance to nearest: Well .-------------------------------- ----Foundation :---------------- Plop. ine ------- -------- REPAIR/ADDITION{�Pr6�"Sanitafion=Permit# ----------------------------------------- -- Da#e --------------------------- ------ i r Septic Tank (Specify Requirements( P ------------ ---------------;---....--------------------x;.---•- X Disposal Field {S ecify Requirements} ___--� l�l,:t-� i 't"" --",-v ---------- - --------- -------------------------------------------- ------------------------ --------------------------------•' '---------------- -------------------------------------------- --------------------------- (Draw existing and required addition on reverse side] I hereby certify that fhcve prepared this application and that the work will be done-in accordance lith San Joaquin County Ordinances, State Laws, and Rules and Etegulations of the San Joaquin Local Health Distrlct. Home owner•o ylicer,- sed agents signature certifies the following: "I certifythat in the perform Y ance of the work foi which this permit is issued, 1 shall not employ any perso i in such manner as to become subject to Workman's Compensati.o laws of California." Signed --- ------ ---------------- ---- -------------- } --------------------- Owner F; By ---------------------------------- _ Title=:_ _. - _ ------------------•--_-. -------: ------- {If other n owner} R E ARTMENT USE ONLY rt q i DATE __. APPLICATION ACCEPTED BY --------- -- - � - - _ •�i�=--- � ----- BUILDING PERMIT ISSUED -__-------- - -_- -- -DATE -,-------------------------- -- ---------- - -- --- -- - ----- - ADDITIONALCOMMENTS ------- ------ --- --------------------------------------------------------------------- ----------------------------------- ---- --------------------•-----/` i -'------------------------------------------------------ ------------ --•-------•------------------------ ------------------ ----- ------------------------ r i ; ------ -------------------------------------------- -- ---- - ----- - ---------------------------------- --------------------------------- ------- --------------------- ------- Final Inspection b - ----- -- - --- - ---- ---------------------------------- ----------- -------------:Date `, = AQUIN LOCAL, F#EALTN;DISTRICT E. H. 9 1-'68-'R�eV° M