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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------- -_71--a 7 ` ''II /__ (Complete in Triplicate) Permit No. _4__ -(�--- ----------I----414-1---------------------- 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 the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. - Aakery-D JOB ADDRESS/ OCATI fU- 2Irl p ry,s_ �#* CENSUS TRACT _____.________---_-_.--� Owner's Name -----------�3se_ ------ ---------------------------------- --------- ---------PhoneY77_---X770-------_- AddressCity --- ---------- Contractor's Name .--_---_--_I ___ __ __ .. ____ License # Phone _t/64---p6 4 Installation will serve: Residence VApartment House❑ Commercial ❑Trailer Court ;❑ I Motel ❑ Other -----------------------------------=--•----- Number of living units------ Number of bedrooms _...__Garbage Grinder --- -------- Lot Size _.__-_� _____________________ Water Supply: Public System and name ------------------------------------------------------------------ -' -. ---------------------Privatex LSa•. Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 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.) 0 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK "'Size_____-5.5c/6__JI __________ ------ Liquid Depth __�� _r/----------- ,,,,�, -ep .-- Capacity i_--._ Type _9994!_ _ _._ Material_ J _.___ No. Compartments ------�. Distance to nearest: Well -------.�`�_Q------ --------------Foundation -----Z0_"f'----- Prop. Line '``__._-___ LEACHING LINE No. of Lines --------3_ ---------- Length of each line-----/-_-____._____ Total Length __3-Cv__`______._-__ 'D' Box .___.✓_ Type Filter Material __IZt __.Depth Filter Material:____/_e-----------------................. _ - x Distance to nearest: Well _ _SD_�'_________ Foundation .___/��_�______ _ Property Line __ ___..�'.._.__...... SEEPAGE PIT Depth ,__,,�_ _�__ Diameter " �❑ p -._ _ _1�..�.__..__ Number _.____._�_______________ Rock Filled Yes No Water Table Depth ------------------------------------------------Rock Size ---- 1- ---------••--- 01 i� Distance to nearest: Well ------ Q_1?`` __---------_Foundation _.--- Prop. Line __S__.____-_-_.._- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------._-__.-_-) SepticTank (Specify Requirements) --- -----"---------------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ---------------------------~------------- ------------------------------------------------------------------------------------------ ------------------------------------------------------ -------------------------------------------------------- (Draw existing and required addition on reverse side) 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 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 ------------ 4/t --------- --t------ - -- -------------------------------- Title - ------------------------------------- (If other an owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -------------------------- ---------------- -------------------. DATE I -'_ �_"7I------ BUILDINGPERMIT ISSUED ------------------------- -------------------------------------------------------------------------------DATE ----- -------------•------------------••-•- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - - --------------------------------------------- ----- --------------------------------------------------------------------------------------------------------------------------------------- --- ------------------------ --- -- -- Final Ins b Inspect-ion Y - Date ection - /l SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M