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FOR OFFICE USE: APpLICATlO FOR SANITATION PERMIT � --------- ------------------------ Permit No. �v�--9� (Complete in Triplicate) -------- --- --- ---- ---- J 7 Date Issued - -- ---------------- --- This-Permit Expires 1 Year From Date Issued II Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein r described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �f ail JOB ADDRESS/LOCATION --I0_/1-------'-t-41 ------- ---�------------------------ -------------------------:----CENSUS TRACT -------------------------- o s i Owner's Name __ 1 '""6-+------------------- Phone .7 ' 9 ;/ { - -- - Z ----- --- ----- - - - - ------ - ---��----------•--. City -- - - - - --------------------------------------•---- Address __- _. [ Q Contractor's Name _-- -_a .---`--- - - -- ------------- --------License #a�_W11j---- Phone Installation will serve: Residence ❑ Apartment House'❑ Commercialxrailer Court ❑ } Motel ❑ Other -------------------------------------------- i Number of living units------------- Number of bedrooms ------------Garbage- Grinder ------------ Lot Size _4ye _ -----II . II Water Supply: Public System and name ----------------' ----------- -----------------------------------------------------•-------------------------Private^ 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 _.___-__.______.___- r (Plot plan, showing size of lot, location of systerh 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,) i !l PACKAGE TREATMENT [ ] SEPTIC TANK' E 'ze_K?1 X9X_ 9------------- Liquid Depth .___7:__-_________,..__ cit L 0�-® �p ref _ No. Compartments --- 11-I Capacity YPeVrMaterial --------- --- u M ' Distance to*nearest: Well ..:/�Q_---__t-____-____Foundation _�,-_-- ------ Prop. Line _I'___A"- .. .4 �s LEACHING LINE � No. of Lines ----___ Length o e lin _ S.____ "---- To#al Length __ q. _ ie -- `� 'D' Box --- ---- Type Filter Mater* _ _Q_ Depth Filter Material ___ -___.__._ _ _- - ._ Distance to nearest: Well j_ Foun®r, __,�do------------ Property Line '"' 'k SEEPAGE PIT Depth _ _._____ Diameter- _��- Num ------# --------- ---- Rock FilledYes No i❑• s---- I-------- ock SizeCWater Table Depth �? Distance to nearest: Well �Q____________--------------Foundation ---�. ------- Prop.Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------ ------------- Date ____-_______________ --------------I Septic Tank (Specify Requirements) ------------------------------------------ --------------------------------------------------------------- -------------- Disposal Field (Specify Requirements) ______________( ° -------------------------------------------------------------------------------------- --------------------- - -- - ' ----------------------- ---------------- ------------------ (Draw existing and-required addition on reverse side) r �� I hereby certify that I have prepared this application and that the work will be done in accordance with 5 n Joaquin • County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District.Nome owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for whiiLh this permit is issued, I shall not employ any person in such manner 9 as to beSe s b ect �o W rkma Compeniati.o -1 ws of California. I Signed -- ---- ---t9w�EPARTMENT ---------- Own_ er ; SY -- � ----------- Title -------- ------------------- ------ ----------------------------------- ✓� . (If other`than owner[ 175E ONLY APPLICATION ACCEPTED BY __-- DATE ...... --------------- BUILDING PERMIT ISSUED ---- --------- ------------------------I--------------------------------------DATE ------------------------i�------------ ----- ADDITIONALCO MFNTS _ ------- -------- - ------------------------- ------------------------------------- ------ ---------------=------------------------ _. Jr X7-21 -- ----- ---------------------------------------------------- - ------------------------------------ ----------------------------- --- ------------------ E -----------------=---------- ------------------------------------------ -- ---- -- ------- Final inspection by: .----- '--- ----------------------------------------•--------------------- -----------------.Date --- = "7 ------ �. AN JOAQUIN.LOCAL..HEALTH .DISTRICT„ E. H. 9 -1-'68 Rev. 5M I �1