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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT !/ --------------------------- -------------- -------------- Per No. / --- -�-- (Complete in Triplicate) -- -- - ----- Date Issued - --" --' _ This Permit Expi esyl Year From Date Issued Application is hereby made to the San Joaquin Local HealtW 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 ancol Regulations JOB ADDRESS/LOCATI - - --- ----- CENSUS TTRRAC-T -------------- ------ Owner's Name ----- ",---- ------ - -Gam'- -------- ------------- Phot Address --------------------------------- Vv- ------ ------------------- ---------- � / � -,-xCitY Contractor's Name --------------- - -- --- - ------ - -------------------------.License # f s Phone 7- t 6 Installation will serve: Residen aApartment House❑ Commercial :E]Trailer Court i❑ / y Motel El Other ----------------- -- Number of living units:---.-[_ . -'Number-of-bedrooms --- --_--Garbage�Grinderl---- __--_ Lot Size __-� a __0------------- I Supply: Public System and name,_.~- 1------------•-------- _:.. -- ------- ----------------- Private ❑ Character of soil to a depth of 3 feet and'[]--Silt❑ Clay El. Peat El Sandy Loam El Clay Loa ❑ t Hardpan �]. Adobe: Fi. Materia- - if Yes,tYPe ---- }' -- -- {Plot plan, showing size of lot, location of �sfem-in tion to- wel s� buildings, .etc. must be placed on reverse side.} r �p seepage pi NEW INSTALLATION: {No septic tank or t permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ I SEPTIC TANK.[ ] Size----------- ----- ----�"------- Liquid Depth --------------------------- V 1" Capacity ------------- yre ----------- Material --- --- No. Compartments f Ii Distance to nearest: Well>. .-- ndat�ion - Prop. Line LEACHING LINE [ ] No. of Lines --------_______---- -_ Length of each line-- J------------------------ Total Length _-----_-____---__-----_-._ 'D' Box ---------- Type Filter Material ------- ------------D�pth-Filter-Mat riot f Distance to nearest: Well ------_-- Found'ifi on ------------------------ Property Line --_-_--__--__-_--._:---- I 1 t _- Number ---------------------------- Rock Filled Yes ❑ No SEEPAGE PIT Depth ------ Diameter ------------- 1 .3 Water:Tabl 61'p'4 h - ------------Rock Size ------ --------------- t Distance to nearest: Well -------------------------------• -----=Foundation ---------_---------- Prop. Line ----------- ---------- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ Date _--_-------.---_-_---_------------1 Septic Tank (Specify Requirements} ---- )------------------------ -----------------------<_-------------------- Disposal Field (Specify Requirement ) -__- _ _-__-_-_ _- -- � P OD -�/-� (Draw exi tin and-re wired-addition.orn-re er..ses� f . 1 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 k as to become subject to Workman's Compensation laws of California." v t Signed ----- - ------ ------- ------ Owner ' ------------------- --------- ' By ------- - - - ----- Title -- (If than owner) FOR DEPA1tfMENT USE ONLY APPLICATION ACCEPTED BY - 7#�. �, DATE Via'/ -69 BUILDING PERMIT 155UED . 7-.?�----------------- -- ------ - ---------- DATE , Al�TIONAL OMM NT ------ �` ��F ---------------------------- - - --------------------------------------------------------------------------------------------- - ------- - ---------------- i -------------- ------------ -1-MV-------- Final Inspection b -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M