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I& OFFICE USE: P.� � A �C ATI � Permit 'dv2<< 9� - /" it ---- ---� " ON FOR SANITATION PERMIT---------- ---------------------------------- (Complete in Triplicate) Permit No. --- - ------ -- - - ------------------- ------------------------------------ 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 at plicanti a ,com li ce with County Ordinance No. 49 and existing Rules and Regulations: JOB ADDRESS/LOCAON . ______/ __ �(__ _ ___-- CENSUS TRACT ---------------------_-- TI Owner's Name�./!__-C:L'+if.'r�4!y_ -- -------- one !lI � �:� Address ---------�p4 1S�`jr L(! _ City - -----------•----------------------------•--- *�ontractor's Name -------- ., ---------------------------------------------------•---------.License # ------------------------ Phone -----------------------_----- CA --------------------------•-- Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court 7i ] Motel ❑Other ---------------------- --------------------- Number of living units:____!____ Number of bedroom Garbo a Grinder Lot Size�! �__Q -f-------.-- Water Supply: Public System and name ----------------- ___--�--_---_--GL_ -_------_---___-_.---------_--_-----------•----•--•-----Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam F-1 Hardpan ❑ Adobe ❑ Fill Material ___________ If yes,type ______________-_-__________ (Plot plan, 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 seepage pit permitted if public sewer is available within 200 feet,) -6, PACKAGE TREATMENT [ ] SEPTIC TANK:K Size_____ _ ____.___________ Liquid Depth Capacity ____`��_,__ Type fIMAbl_ Material___ _C-r .No. Compartments ____ Distance to nearest: Well ____ !)h< AFoundation ---1 "�- _ _-.._.. ''. Prop. Line /►/ LEACHING LINE X No. of Lines ------- Length of each line___�Q__P`_ L?__ Total Length ,___Jc ©-C_-e._._ 'D' Box Type Filter Material --------Depth Filter Material :___14__ ------------------_ - Distance to nearest: Well _jY __ '_ Foundation :1!7__ Property Line ...... ....... ......... SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ . ' Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ---------------------------------_......Foundation -------------------- Prop. Line ...................... , 17 REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ________----._------_______-__--__) Septic Tank (Specify Requirements) 4 J ----- - _ --------------------- O U-71/73 -- - ,t Disposal Field (Specify Requirements) ________ __ ________Y.._ ��t __ __C�7i�t�L_______________ __ _.______ ___ _____ _-- ---------------------------------------------------------------------------------------------- --- �`�/ - t..F�" -------------------------------------------------------------------------------------------------------------I-------------------------------------------------------------------------------------------- (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 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 becom subjecZo orkm 's Compensation laws of California." Sign - -- - ------------------------------------------------- Owner BY --- -- - --- -- ---- ---- ---- --- Title ------------------------------ (If other than o r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------'- ----------------------- --------------------------------- -------- DATE � C �j ------------ BUILDING PERMIT ISSUED -- ----- ----- ---- ATE ---------------------- ADDITIONAL COMMENTS - - ------- -------------------------------------------------------- - - - -- ---- - - - - - -- - - - - -------------------------------------------------------- -------------------------------- c -- 4 - --- ' �' ------ -- ..... �� Final Inspection by e -- --------- ---------------Date ------- ---------------------------------------•---------------------- - - - �'-- - ---------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M