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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �S�� - �""`,....: Permit No. I- 6 0/_ Z ----ILI --------- (Complete in Triplicate) . _______ ______________________ 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 compliance with County Ordinance No. 549 and existing Rules and Regulations- JOB JOB ADDRESS/LOCATION ._-- -- -- ------(_)Au = -------A Lf_-P--------------- ------CENSUS TRACT -------------- ......... Owner's 77_2_� _f_V_k ------ P- 40-h-�--n� -------------------------------------- --- ---Phone �_Ur_�—119_5 . Address - -,11-----------------------------------------------•------------------------• City __/!__f v-C-/rt_�_,,1_,--------------------------------------- Contractor's Name --------------------•---------------------------------------------------------=-------.License # ------- -------------- Phone ------------------.._...------ Installation will serve: Residence [Apartment House^❑ Commercial ❑Trailer Court ❑ Motel ❑Other ----------------------------------"•-------- Number of living units----L_------ Number of bedrooms _______Garbage Grinder -----------. Lot Size ______�/S__.-r __I�-___C!<___....._ Water Supply: Public System and name ---------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt E] Gay ❑ Peat❑ Sandy Loam fl Clay Loam L Hardpan ❑ Adobe 0 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.) t NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ) PACKAGE TREATMENT -- [ � SEPTIC TAMC�[ l Size------------`-- ------------------- ------------ Liquid Depth - -- --------- .-• •,- Cap'acitNo. Compartments _____-_-_. Y - - --- Type -----------------=-- Mafierial----------------------- --•---=---- Distance to nearest: LinePro Well ------------------------------------Foundation ---------------------- p. -----._--- __----__ _ �i LEACHING LINE [ ] No. of Lines ____.__._.__________ __ Length of each line ------------------- Total Length 'D' Box ------------ Type Filter Material ---------------------Depth Filter Material ____________________________________.____-_ Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ____________._____-_____ SEEPAGE PIT [ ] Depth -------------------- Diameter ----__---_ Number __________________________ Rock Filled Yes ❑ No .0 Water Table Depth ------ -----------------------------------------Rock Size -------------------------------- Distance to nearest: Well ------------------------------------------Foundation -------------------- Prop. Line ................... --- REPAIR/ADDITION(Prev. Sanitation Permit# ---------11V-7r- vj�__________________ Date ---16AA-153------ l .. SepticTank (Specify Requirements) ---- ---------------------------------------------------------`---------------------------------------------- ... ----------- r Disposal Field (Specify Requirements) -------- -- ---- --- n- ----------- 41 it ---- ------ ' a l - 1 ------------------ --- ----------- 1 �- = .10 -- -- - -- --------- - -- .P fir.--- ----- ---------- ��2 •� 1------ ----- --------------- { - - - -- ----- --- -- - --�reuir_ecl - --------------------------------------------------------- -- ----------- (Dra exis-t and addition on revere side) I hereby certify that 1 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 become subject to Workman' Com ensation laws of California." Signed ---------------------- Owner zr By ------ -------------------------- --- ---------------------------------- Title -- t ---------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- __-- - DATE --Y -- - -�..- •- - --- -- - - -- BUILDING PERMIT ISSUED ------------------------ DATE - ------------------------------------------------ ----------- ADDITIONALCOMMENTS __. ------------ --------------------------------------------------------------------------------------------------------- ----------------------------------------- == `- --------------------------------------------------------------- . r- j/ L_r --------------------- ------ ------ - ----------1-1 ----Final Ins ection b -- �P Y - X L 'j' ----- ---.Date -- SANAQUIN LOCAL HEALTH DISTRICT 4 E. H. 9 1-'68 Rev. 5M.