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t FOR OFFICE: USE: ` APPLICATION FOR SANITATION PERMIT i Permit No. 1+ ------ ---- ------- x (Complete in Triplicate) ;� ; Date Issued p This Perri�it Expires 1 Year From Date Issue - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein -------- pp lication is`made in compliance with County Ordinance No. 549 and existing Rules and Regulations.- described. egulations: described. This app ' CENSU RCT A-I `C.._.. JOB ADDRESS/LOCATI ---------------- - _ _ - _ ---�_r_ - -- -Rhone --.---- --- Owner's Name ------- - - # - - #`* Qt c = =-------.. City --- ---------------------------- Address ---- ---- --------- - --- Phone � c/Gb- oT Contractor's Name ------------ ------License r. Residence Installation will serve: e Apartment House Commercial ❑Trailer Court ;❑ i � Motel ❑Other ----------------------•-----------m--------- r f --------~1iSo -----.--•-- Number of living units:___(-- -- Number of bedrooms _- --_._Garbage Grinder .__..____.__ Lot Size -��------ vat Private Public System and ri r -t j-- ------ - Water Supply: y ame,:� ---------te Y ' - - " 1 M Peat Sandy Loam ❑ Clay Loam -❑ Character of soil to a depth of,3 feet: Sand'❑ i Silt❑---------- Clay ❑ ❑ - -- If Yes,type ------------------------ Hardpan ❑�'6-Adcbe� Fill Ma#erial ` �n � —� � r laced on reverse side.) 00 (plot plan, showing size of lot, location of_Tsysfiem in relation to wells, buildings, etc. must be p i it ermined if public ewer.is available within 200 feet,) NEW 1NSTALLATION: (No septic tank or seepage p' P r i l S Ze Liquid,Depth . --------------- ,SEPTIC ----------- - PACKAGE TREATMENT ( ] ,SEPTIC TANK: :, I X�------- ---------' ��-- `- '�"'�•-�-----� No. Compartments Materna! Capacit - - -- --- -- Foundation --- ------------ Prop. Line _ ------- Distance to nearest: Well ------------------- i r U -r Length of each line----- - - Total Length ._�7--__. `L•EACHING LINE No. of Lines I-----�Z -- ------- o' YP 1� ---Depth Filter,}Material ----A- ------------------------- 'D' Box .---v- T e Filter Material - ---- ------ ---_OL_... Distance to nearest: Well .•y_ 0-- -�-* Foundation /_—------ i- Property Line. �=- " Rock Filled Yes No i❑ -,----- Diameter Number ---------�-- ---- " `F::SEEP PIT ' Depth �'S I rI � Water Table Depth ------- Roclr Size�,�_ } � �f- I l0 Pro Line ---------------------- Distance to nearest: Well --_-I - ---------------------------- . • L__' -------------------------------------------- pater---------------------,----•------) REPAlR/ADD1TlON(Prev. Sanitation Permit { -------------------------- - - Septic lank (Specify Requirements) ---.--- -- .,.s -- Disposal Field (Specify .Requirements ----------------- ----------------------------------------------------- ---= ---------------------- i 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 Larws-,—ard--Rules'and'itegvlotions of"the San Joaquin Lor alJHeallFi'District. Home owner or licen- r sed agents signature certifies the following: 'Y-�0`,t arson in such manner "I certify that in the performance of=the work-for- which this permit is issued, I steal! not employ any p as to become subject to Workman's Compensation laws of California." Owner Signed ---------- - - - 7iNe - ------------------- -r--------------------------- i (If other an owner) FOR .DEPARTMENT USE O LY DATE _ - ------- APPLICATION ACCEPTED BY ----- ---- --- -- ��--------------- ------------- -DATE -- -------------------------------------- BUILDING ----- ------ -------------- ----------- ADQIDTIONAL Co ISSUED ENT _ __. ------------- --------------------------------- --------------------- --- - iA--JG7-'1+ �� = *-� 5�i.. ------ --- --------------------- ----- --- - ----- - - ---- --------- -- ----------- ------ ---- - ---- ---- ------- ------ --- ------- Date � - �- -- ------ --- -- Final Inspection b SAN JO AQ N LOCAL HEALTH DISTRICT G u 0 1-'68 Rev. 5M