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FOR OFFCk Uac^ APPLICATION FOR SANITATION PERMIT 4� ---- ------------ ---- ..a%- (Complete in Triplicate) Permit No. ---------------------- --- --------------- --- -- --------- Date Issued _-R—l_- ----------------------4-no----- _----- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: t3- ,F d ----------------- --- JOB ADQRESS/LOCATION -� �---,--�-- '-- _-��_�'Cl-------- ----- TRACT ___��-`--p § Owner's Name -------------f1e1 �Q /----•-------------=- ''-- -------Phone Address ---------A---�''---'a3------ 0 =X. r `-------=----------- Cif ~ I --------- p_�rV . F .�� 7 . I Contractor's Name License #'--- _/04-- =- Phone Installation will serve. Residence W Apartment House,C7 Commercial ❑Trailer Court ❑ t Motel ❑Other --------------------' -:----------=------ , _ .- T - Number of living units:--_ ______ Number-"of bedrooms ____----Garbage Grinder _��__-_ Lot Size __�_�___�G_��S � Water Supply: Public System and name ------------ ----------------- ------- --------- -- "- 1 --------------------------------------------------------- -------Private Character of soil to a depth of 3 feet: Sand'R] Silt❑ .�Clay ❑ Peat❑ - Sandy Loam 'D Clay Loam ❑ r x Hardpan ❑ Adobe-E] Fill Material ------------ If yes,type -----------_________________ (Plot plan, showing`. size of lot,,F location of system;in relation to wells, buildings, etc. must be placed on reverse side.) W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is ovailabl within 200 feet,) ' PACKAGE TREATMENT [ I SEPTIC TANK:[ ] Size--------- --------------- ------------------ Liquid ..Depth _-------------------...--- ____ Type _ _ __ Material________' ___.:_-__--_ No Compartments -------------_--------- Distance Capacity ---------�----- YP -------------- --------------•--:---- Distance to nearest: Well _ ________Foundation ----------- ---------- Prop. Line ___________ '------- ------------------------ LEACHING LINE [ ) No. of Lines ------------------------ Length of each line________��------------ otal' Length _,Depth Filter Mate ial ----- --------------------------------D''Box`" "" " Type Filter aterial _:_________ Distance to nearest: Well ___ __-_______________ Foundation _ _------ -- Property Line. _____________________ i SEEPAGE PIT [ ] Depth ____________________ Diame er _______________ Number -------------------------- _ Rock Filled Yes ❑ No 0 Water Table Depth ------- - ------------------------------------Rock Size ---- -- ------------------- Distance - ------ --------Distance to nearest: Well _ ___________________________________Foundation ______ ---------- Prop. Line __________---`•--__--• REPAIR./ADDITION(Prev. Sanitation Permit# -------- -------- ---------- __ _______________ Date _________ _____1______________J -= Septic Tank (Specify Requirements) /-/J' fa --= OD---614�----- � �' :---------f'_-_-._. r,�e�?P'- Disposal Field (Specify Requirements) -5(i`-� '--------);1Ox ��r-----r -----�-p�-r�--------/--�-�------------------- - ----- -------- -------e---- h'r ry---------------------------------------I------------------------ --------------------------------------------------------------------- ------ ----------------------------------------- __ (Draw existing and required addition on reverse side) I`hereby certify that I have prepared this application and that the work will be donein accorclonce 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 t as to become subject to Wo`rkman's Compensation laws of California." ! t Signed T/ }� ------N---------- Owner ! BY ----------- -/. ---- -------------------------------------------- Title ---------- ------------------------------ ----------- - -- - � [If of er FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_�.,_R_C_r-----------------------------------____-- -------------------------------- DATE77-=31 -;70--------- BUILDINGPERMIT ISSUED ---------------------- ------------------------------------------- -------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS - ----- --------------------------------------------------------------- --------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --=---------------------------------- - - --------------------------- ---- ------ ----------- ---------------------------------------- ----------------------------------------- -------------------------------- - - - ---- ----- - - - - - - ------ --------- ----- - - Final Inspection by r es ----------Date ----Q--o 7`----l__ 1` :" --------0_2 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1.-'68 Rev. 5M