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FOR OFFICE USE: - APPLICATION FOA,SANITATION PERMIT ------------------------ (Complete in Triplicate) Permit No. .._7__ = k_P) ________-___-_-.-___-_-_-___--_ ----------------- This Permit Expires 1 Year From Date Issued 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 complance with Cpt,�r Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-_S__.1-T_1_[_?� j_-___ __ __��____ _____ _CENSUS TRACT ------------- --- --------- Owner's Name �- C� F ?_76.4�`5.__..___ ---� ---�----------�1--1--- - fr'+ .............h� City !�`.eC/7r 'l Contractor's Name ---- _0------ ` � =1 ------------------------- L" �r ___._.License # 5�3 �_ __ Phone �- = `? Installation will serve: Residence N Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:----- ----- Number of bedrooms 3------Garbage Grinder ------------ Lot Size'a_eg!?!� ___-_____--___.-----•- Water Supply: Public System and name ------------------------------------------------------------------------------------------- ---------- ------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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 i�P public sewer is a_v_ailable within 200 t PACKAGE TREATMENT [ ] SEPTIC TANK [ ] SizeLiquid Depth ' ______________ Capacityf _ . __ Type ' _ Material -'- � _--iP___ No. Compartments Distance to nearest: Well ----- __________________Foundaton / ---------- � Prop. Line _S____ LEACHING LINE [ ] No. of Lines -----5a___ .------------- Length of each line----17_._Q----__------------ Total Length 'D' Box ___�___ Type Filter Material � Depth---/�--- Filter Material �� o � Distance to nearest: Well ___ _____________ Foundation /---------------------- Property Line _�................... SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes F1No Water Table Depth ------------------------------------------------Rock Size -------- -------------•--------- Distance to nearest: Well __________________________________ _•-Foundation -------------------- Prop. Line ....................._ REPAIR/ADDITION(Prev. Sanitation Permit# -------_------------------------------------ Date ----------------------------------) SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------------------------------ --------------------------- DisposalField (Specify Requirements) -------------------------------•---------------------------------------------------------------------------------;------------------- -------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- (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, 1 shall not employ any person in such manner as to become subject to Workm n's Compensation laws of California." Signed - - - - ------` Owner By -------------- �� 2= G r -------------------- Title ---------------- ------------------------------ -------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- --------------------------------------------------------------- DATE -----A-6_-__7yf ...... BUILDING PERMIT ISSUED _ _ . -'.e_�►. ' £ m _------_. _DATE ------------------------------------------- TS _. -_-_ -___ _ _ .._ TSADDITIONAL COJVME ------------------------------------ < w ,, ,P _ Q=-------------------------------- ---------- ----------------------------------------------- --- -------------------------------------------------------------------------------- ------------------------------- -------------------------------- -- - -- -- ----- ------- ---------------------- - . Final Inspection b ------------------------------------------------- --------------------Date --�---> �7 ------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M