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FOR OFFICE USE: T�. APPUCATION FOR SANITATION PERMIT j (Complete in Triplicate) Permit No: 7�_ -- --------- -----_---- -7 -------------------- -------- --_ ____-�_[_----. This Permit Expires 1 Year From rate Issued Date Issued Application is hereby made to the San Joaquin Local Hdlth District for a permit to wstruct and install the work herein described. This ppl'ication is made in-compliance with County Ordinance No: 54'9ZTfi existing Rules and Regulations: JOB ADDRESS, OCATION .__?_3 0 6-----/ l/ rl -------------------------I------------------CENSUS TRACT Owner's Name ----A0P- ------ -----------------r---------------:----------------- -------Phone Address -------- --- --- .Q ------------------------------------------ City ,?t�V-7------------------------------------------ Contractor's Name --- - -—le,tp -f'-----------------+-------------------License # /49� ZQ -- Phone Installation will serve: Residence Apartment House,❑ Commercial :❑Trailer Court i❑ •x. �.. 1 Motel ❑ Other -------------------------------------------- e Number of living units:---- __-. Number of bedrooms _S Garbage a Grinder �� Lot Size -/�OJ ---,C_49C�..________ Water Supply: Public System a d name --------------- ----------------------------Private ❑ Character of sodto.a depth of 3.feet: Sand'❑ Sift❑ Clay/ ❑ Peat❑ Sandy,Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe. Fill Material ----- ------ If yes,type _________________________ (Plot plan, showing size of loft, 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,) �t � � - f : 41 PACKAGE TREATMENT 'Ca aySEP71C TANK Size_./X/4X4 ____________________ Liquid .Depth �>______-__.-_______ p city _�_aa------ Type/,W/A�� Material `----- No. Compartments --gym--------�-_.. o � � Distaneo nearest: Well ------ ---------7------------------ f! ___---------- Prop. Line/ ---- ---------- LEACHING LINED No. fof Lines _-_ ________________ Length of each line____ t �_- �:_._.____ Total Length ---,___-____ I f p �/- t /� 'D' Box f/�f' . Type Filter Material/t__ Filter;Matenal _____________._ _______•--._....__._ Distc nce to nearest: Well _._"�""__.________ Foundation �2 d'---------- Property Line _ :__`-_____._-____ i ! ,e f SEEPAGE PIT Depth! _. _ ........ Diarreter _ _____ 'Number --------- --------- Rock Filled Yes ' No I❑ Water'Table Depth -------z�s---------------------------------Rock Size1----'--'_sa?--------------- y el Distance to nearest: Well _____________ _�_______ ______________Foundation + :µProp. Line _e<4_----------- ,d REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date -------------- ___..-------_------ ) SepticTank (Specify Requirements) --------- t----------------------------------' :------------------------------------------- ----------------•-------------------------•--- Disposal Field (Specify Requirements).-r-, .�-------------------------------------------------------------- ------------------------------------------------•----------- -------------------------------------------------------------------------------------------------------------- ----------------------- -- ---------------------------------------- -------- --------------------------------------------------------------------- -- ---- - i (Draw existing and required addiiion on reverse side) I 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: R "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." A Signed --- --------------------------------------------------------------------------------- ------ Owner 1 BY Title ------------ ---------- ---------------------------------------- (If other than owner) FOR .DEPA1tTMENT USE ONLY, DATE 14 APPLICATION ACCEPTED BY ------- - - - ----------------------------------------------- '` � -'- ------------------ DATE ----�-.1�-1-b------------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------ I---------------- --------DATE ------------------------------------------- I ADDITIONALCOMMENTS ---- -------------------- ----------- ----------------------------------------------------- --------------------------- -- ------------ --- ---------- ------------ s F ______________________________ _ ^ _ 70 Final Inspection by: Date t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. �