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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT t................... ....................... (Con)plete ira Triplicate) Permit No. ._A".&.7 This Permit Expires ] Year From Date Issued Date Issued r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein II described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .:..._ �y -•... ,/YQ :., � _ G'�.....CENSUS TRACT ...............:.......... i Owner's Name . .._...-_ ._.. ._.. - --.... �/ .. ...........................................Phone �� c Address .........................�•9 !I..._....._.-..................... .......................... City -. ..... L � `....... Contractor's Name ...... �... .. --........ ...............................License # 17s _S., --- Phone Installation will serve: Residence Cy Apartment House I] Commercial ❑Trailer Court 0 - _Motel [j_O.ther............................................. _ Number of living units:.._____.. Number of bedrooms ...3....Garbage Grinder .. Lot Size ... d...!........................... Water Supply!Public System and name ------------------------------------ i. ----- ..........................................Private Character of soil to a depth of 3 feet: Sand n ..Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpon12 Adobe '0 Fill Material ............ If yes,type .......................... I (Plot plan, showing size of lot, location ofsystem is 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 Size..___ �` '� � ] �------�----..�...-----•-------------- Liquid Depth ...-_ti?�..��......_._...__._� � r s� i Capacity .lr Type�, -,-C�a Material. No. Compartments ani........... Distance to nearest: Well ...fc P.f'____________________Faundatiron . .............. Prop. Line _. ,f ..........DO' LEACHING LINE [ ] No. of Lines Length of each line.- ..............:. Total Length _ . . {.� 'D' Box ----1..... Type Filter Material !'��ADepth Filter Material ...1 ......................:... s Distance to nearest: Well --AF°r?.----.---. Foundation _ r'............... Property Line ' -_-- �` -- _. ....... iT i SEEPAGE PIT [ ] Depth 4� p'-- Diameter ................ Number ....,-a................ Rock Fillet! Yes 5d No ❑ } : Water Table Depth .........................................--......Rock Size Distance to nearest: Well ..................•.....................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............ Date .................................. } Septic Tank ISpecifY Requirements) .-.................................. ... . ... (�6 q I .....__... •-••-----------------------------------••---....._. ....-----...._....---•- Disposal Field (Specify Requirements) -•-- ..................... --•---------------•--•--- •------------ ..... f I I --------------------•------..---- I F (Draw existing and required addition_on de) reverse side) } a- I 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 fall- 1'9Y "I certify that in the performance of the work for which this permit is issued,1 shall empioy.any person;in such manner ' as to become subject W an' mpansation laws of Califotnla-.11_i I Signed �.... ., _.... ' Owner i i BY a y"" \ ------------------- I T F.;_ ------------------- --•-• , itis . - - (If other than owner) � r <,r.k'f'y ��:;•� .��-._.._.....--• _I ............ O PAR ENT i WE ONLY_,, APPLECATION ACCEPTED BYE ....:`:::.: .�..... .. DATE ...� _ .... = ✓ S BUILDING--PERMIT-ISSUED-- .__._— < _.__s.._ ,. -- DATE -........... .. ADDITIONAL COMMENTS h, - r• i ............�.�,..�....-,.�._m.. �._.............� .... .... r� .T .. . .. �Y �� .. __.._.. _ ................•--�-•�.........ten_ Final Inspection by: --- ......................................................................... G ` -- 's ------•• -- ------ ........ ................•---..._.......---............_...__...........--.................Dole _... _ SAN,JOAQUIN LOCAL HEALTH DISTRICT # E. H.13 24 1-'68 Rev. SM 7 1 u !