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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ --------------- Permit No. _.��_"_3 ---------------------- (Complete in Triplicate) t - I Date Issued --------------------- --------------- This Permit Expires 1 Year From 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 n Regulations: JOB ADDRESS/LOCATION / &--- �- - CENSUS TRACT Owner's Name -------P--,}--------ka = ---------------------------------- ------------------------ ------------------------Phone ------------------------------------ Address ------13--4; Q --------------------- City _7A � •------------- --------------------....... Contractor's Name -------------------------------------------- License Phone--c70:—/'/�� Installation will serve: ResidenceV Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ----------------------------------------- Number of living units----- Number of bedrooms ------Garbage Grinder ------------ Lot Size --------------------______._-.___-_-___-____ Water Supply: Public System and name ---------------------------------- ------------------------------r------------------------------------•-------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay en Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ----------F:_ If yes, type ---------------------------- (Plot ________________________ __(Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank or see a e it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT, [ ] —SEPTIC TANK:j Size_____ �,t _�-___._ Liquid Depth -__-� _ --f/- -- o ;Capacity _f ----- TypeF� --- Material______________________ No. Compartments > 1 ' Distance to nearest: Well -------------------Foundation _ .__ _______ Prop. Line LEACHING LINE [ ] No..-of Lines ------------------------ Length o each li e---------------------------- Total Length _-- G � - � if--- -- -•-- --- - - -- JY Box __/-------- Type Filter Material _/c��/Dep#h Filter Material _,�„�_________________________________ _ : . +Distance to nearest: Well _ �*_.._- _ Fd>undation ........ ----------- Property Line. __5--.__--_-_-_---_.'fid* SEEPAGE PIT [ Depth -------------------- Diameter _____-:_____-__ Number ---------------------------- Rock Filled Yes ❑ No C3 i7 Water Table Depth_- -------------------------------------------Rock Size ------------------------------: Distance to nearest: Well ----------------- ---------------------Foundation -------------------- Prop. Line -_-------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------- Date__:-------------------------------- Septic _________________.__.-_-------Se tic Tank (Specify Requirements) ------------------------- . -' --------------- Disposal Field {Specify Requirements) ---------------j.___�--- j Is ------------------------------------------------1---------------------- • r -------------------------------------------------------------------------------------------------------------------------------------=-------------------------------------------------------------------- (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 acdordance 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 subie t rk 's Compensation laws of California." _ �54CKF/,C0 Signed Owner o`0 /i�o � --- By -------------------------------------------------------------------------- ----------- --------------- Title-Title -- -------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------ �_ .-�—�— ------------------------------------ DATE ------fZ = =5 ----------- -��__:•-�-----�,,-- BUILDING PERMIT 15SUEQ --- --- -------. --------DATE ------------------------------m----------- ADDITIONAL ------ -- ADDITIONAL COMMENTS -- -- --- ---------------------------------------- --- ---- - ------ - - ----------------------------------------------- - -- '------- -------------------- -- ------ - ------ ----------------------------------------------- --------------------------------------------------- --------- - --- - ---- -`--=--=-=--=---------------------------------- _. ---Date -- --------------------------------------- Final � inspec iorr by =1-�� ---- ---- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M