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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------ Permit No. 0&mplete in Triplicate) --- -------- This Permit Expires ] Year From Date Issued Date Issued ._s'-7_.7 --------- / 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 Ain compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-: ---_ �[l._ "' T--- ----`®--- --vet-bel-79-CENSUS TRACT -------------------------- ----------- ---- ------ --------- - ---- -----------Phone 7 -S ---Owner's Name Nt .11 Address _If - Cit t +� 1W!� Contractor's Name,�-�-------- =r- =--- -11,� - - -- - - ------- - ------------License # ------- �(J�.S�/ ------- Phone P.- Installation will serve: -Residence ;Ap `rtment-House 0 Commercial : Trailer Court ',❑ Motel ❑ Other ---- ----------1---------------------------- Number of living units:_.__ , _ S'`rr� 9 �1__ __ Number of bedrooms ____� _____Garbo e G •nder ------------ Lot Size ___��,�---��------------------ Water Supply: Public System and name --- -------- --------------------�------------- > t.c-fr->Lc.c�----------•----------- ----- Private ❑ Character of soil to a depth.of 3 feet: Sand`' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam '❑ Hardpan E] Adobe ❑ Fill Material Vin___--__ If yes, type --------- -------------- (Plat plan, showing size of.Mlot, locationff�oqf system in relation to wells, buildings, etc. must be{ placed on reverse side.) 44 41 NEW INSTALLATION: (Nb septic tank or seepage pit permitted if public sewer is available within-'200 feet,) PACKAGE TREATMENT { ]. SEPTIC TANK - ------------- Liquid DepthCom No. + .Compartments --------- ------------ Capacity� _6fif Type': 1----- ----______ Material p t Distance to nearest: Well --- --------------------------------Foundaft/ior;---1Q-f--_----- Prop. Line ----. --�"-:____-- LEACHING LINE No. of Lines ------ ----------------- Length of'each line_ ----------- Total Length ?...2_t __--_-_.____ err. E - D', Box -_-_______ Type Filter Maternal 1QQr�---Depth Filter Material -----le 1 O Distance-to nearest._WeH��_____--_________ Foundation --X ---------------- Proper Line ___ _._____--.___-- 11 SEEPAGE PIT [ ] Depth Diameter ________________ Number -_.____-__--_________ ------ Rock Filled Yes ❑ No i❑ Water Table,Depth -------------------•-------=---------------------Rock Size Distance to nea�e :.Well ----------------------------------------Foundation -------------------- Prop. Line --------- ------------ REPAIR/ADDITION(Prev. Sanitation Permit,# -------------------------------------------- Date ----------------------.-----------) Septic Tank (Specify Recidirements) ----------- ---------------------------- ----------------------------------- ----------------------------------------------- ---------- Dispp y equirements) ---------------------------------------------------------- ----------- ----------------------------------- osal Field {S eci lei ------------------------- ---=---------------------- ----------------------------------- ------------ - --- ------ ---------------------------- ---------- ------------ ----------------------- certify "`--(D"raw-existing and regbired add tibn�on reverse side) I herebycern that I have prepared this application and that the work will be done in 'cortlance with San Joaquin County Ordinances, State Laws, and Mules,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--Corripensation laws of Ci lifo-rnia.' " Signed - ------- -- ----- -- Owner _ 13Y -------- ----- ----------------------------- Title --:-------------.-c -- -.-------------------------------------- (If other t owner) " FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY la- --- -f-------------- ------ ------------------ DATE s=� ��----------- BUILDING PERMIT ISSUEDT = DATE ----- -•----- ADDITI COMMENTS �& =?1M �a - •- •� � � a f + r� s"�"� ------------- - ---------- -------- -- -- --- -- --------------------------- ------------------------------------------------------ ------- ----------------------- - { ---------- ------------------------------------------------------- -- ------------•-------------------Date ......Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M