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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' ----- Permit No. __7-3-�lr_Y ' (Complet�in Triplicatel" ----------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein f described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .JOB ADDRESS/LOCATION -- - --27 ---- _------� �_-._�s®----------------------CENSUS TRACT -----S._ Owners Name __ __/ /'Q______ J� -l-/------------------------------- ---- - ----- --------------=-�,-------------- --Phone �---� -- --- ------------- Address _49--.2-2.7------ {JL-- —----------------------------- City Ja42- A/----------------------------------------------------- Contractor's Name ------ --- :--_-1�`_--- ��Q --------------License # ------------------------ Phone _V3 F Installation will serve: Residence $4Apartment House❑ Commercial❑Trailer Court Motel ❑ Other -------- -------------- ------ Number of living units:-.--- Number of bedrooms _______Garbage Grinder _________-__ Lot Size ____________________________________________ _ 4 WaterSupply: Public System and name ---------------------- ----------•-------------------------- ------------------------------------------------Private E F Character of soil to a depth of 3 feet: Sand)9 Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i _ =Hardpan ❑ 4Adobe'D Fill Material -- `.-1f yes,type -- -____--- ----------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) t NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTI C TANK'[ ] Size------------------------------------------------ Liquid Depth --------------------------- { ] � i Capacity .------------------ Type ----------------- aterial-------------------- No. Compartments -----------------= Distance to� nearest: Well/oa - ------------------Foundati _________ ---- Prop. Line ---_-------------_--_� LEACHING LINE [ ] No. of Lines f each linZ ______________ Total Length ----------- -------------- r D' Box ----- _ --- Type Filte ________________ ilter Material --------------------.----------------_ -•�Distance to nearest: Well _____ Founda ______._.______ Property Line _________-_.-.__-,.....- SEEPAGE PIT [ ] Depth ------------ Diam ------ Numb ----------------- Rock Filled Yes ❑ No i❑rn` Water Table Depth ' Distance to nearest: Well __________________________________ ____Foundation •__._.____.__________ Prop. Line __________-____-___ REPAIR./ADDITION(Prev. Sanitation permit# -------------------------------------------- Date ----------------------------------I SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ------------•---------------•--------------------------•- Disposif 'el (Specify Requirements) ----------------------------------------- ----------------------------------- --------------------------------------- --------- ------------------ ---------- 9 -�,7 --- - �1� -� ,�1��-----��-r-- ------��li`cr�------------- '/fit/p2 r i j7t/. _ W. . a. �_ r --- ' Draw existing and required addition on reverse sidel 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 ------. — --------- Title -------------------- (If other than owner) }} i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY s-9. � DATE l ------ a BUILDING PERMIT ISSUED -- - ----------------------------------------------------------------- --------------DATE _------------------------------------------ ADDITIONAL COMMENTS -- -- -- ----------------------a -------------•-----------------------------------------------------------------= --------------------- ----- ---_-'_________ ___ __ ___________ ______ __ _____ _ _ r }____.____��.- __f=inalInsec i - - - _ - - � --------------�- --�"--- � ---------------.Dat -- -------- --- �~-t SAN JOAQU-IN LOCAL HEALTH DISTRICT ,E. H. 9 1-'68 Rev. 5M f