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f FOR OFFICE USES APPLICATION FOR SANITATION PERMIT Permit No. 7U_/_ -•----- (Complete in Triplicate) ----------------------- This Permit Expires 1 Year From Date Issued Date Issued ..___r______`____. Application is hereby made to the San Joaquin Loccf Health District for a permit to construct and install the work herein j described. This application is made in compliance with County Orainance No. 549 and existing Rules and Regulations: 1 ---- �{ �I + 410 CENSUS TRACT - Q JOB ADDRESS/LOCATION _`P�5S 5�,, � - �______._�___ ____ � ` i Owner's Name `-`----------------------------------------- --------------------------------- --'---._Phone __ii . 8A--------------- Address -- �----------------------•--. city A� -----------------,-------------------------------------- Contractor's Name'- ----- - -------------------------=------------------------ -------License # ------------ ----------= Phone ------------------------------ Installation will serve: Residence ❑ Apartment House-E:] Commercial erailer Court Ua ' VSA ?erjn�T W 51 kg i§Qe Motel ❑Other --------------------------------------- �J_Aq-lo Number of living units:___-!------_ Number of bedrooms ___________Garbage Grinder ------------ Lot Size ______________________ Water Supply: Public System and name ---------------------------------------------------------------=------------------------•---------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .❑ Hardpanx Adobe Fill Material AJO--_- If yes,type ---------------------------- (Plot -_-_-__._-_.___----___(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK[ ] ,,-,,Size------------------------------------------- ---- Liquid Depth ----------------_--------- Capacity _.�?� +I Type --------------------- Material- No. Compartments ----��. ______._...._. � Distance to nearest: Well loo`+_ ---_Foundation _____W---------- Prop. Line ..... - - LEACHING LINE No. of Lines - Length of each line--- d�� G ] 9 Total Length -------©-- ;� ff q� ,f a �� 'D' Box ---✓__ Type Filter Material �M�_IM-Ak ept�filter Material - _'G -------------- -L__-..____-_ d Distance to nearest: Well ---VO4r~ ........ Foundation _` -11---------------- Property Line --- _'------------ Depth ._ _._. __ Depth __�_Q_`_-_� __. Diameter ._X _-__ Number --.-_-�----_.-_---_-__ Rock Filled Yes No C] / --- -------- �� `------------------------Rock Size y, .................. < Water Table Depth -=��--�QO -------------------Foundat�o��_. .___ ______ Prop. -1-60 Distance to nearest: Well --------------------- ) �� -� p ------V___ REPAIR/ADDITION(Prev. Sanitation Permit# -------- --- "_------------ ---- Date __________________________________) Septic Tank (Specify Requirements) ---- ------------------------------------=------------------------------------------------------------------- Disposal Field (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 Ilion- s 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 �- C -m ensation laws of California."ans Signed --P-- -- - ---------------------------. Owner BY ------- ---- ----------- --------------------------- • Title ---------------------------- ------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --------- =----------------------- -------- DATE ...... 44-7 ----------------- -- -- ----- - --- BUILDINGPERMIT ISSUED ----- -- -------------------------------- --------- ------------------------------------ --------------DATE -------------•----------------------------- D ITIONAL COMMENTS - - - --• ------ -- ---- �-" ------------- - ----------------------------------------------- -------------------- --------- - -- Date � - Final Inspection by: -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. W 9 1-'68 Rev. 5M