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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � Permit No. _72___-_-5.-_y-72____. Q_�_ _U 2 _ (Complete in Triplicate) - Date Issued This Permit Expires 1 Year From 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 madelin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --- c .� ----� ------------------------- ------CENSUS TRACT --`---------- --------- Owner's Name __�`__Q-- ------ f--�l--� - Phone Address ----- -- ------ --- '! -•--------------------------------------------•--. City ----- '-----------------------------•-_----- Contractor's Name ------------ #----------------------- -------------------------=--------License # ------- ----------------- Phone -----------------------__----- i Installation will serve: Residence 4 Apartment House❑ Commercial ❑Trailer Court I❑ II Motel ❑Other -------------------------------------------- Number ---------------- - -------Number of living units:-----]----- Number of bedrooms ---Garba-ge Grinder ------------ Lot Size ---`J --_____s --_!1-_--Q------ . I Water Supply: Public System and ngme -------------------------------•------------------------------------------ •-------------------------=---- ----Private] Character of soil to a depth of 3 feet; Sand'❑ ❑Silt Clay ❑ Peat El Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe; ] Fill Material ------------ If yes,type G (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 if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size-------s___ J- -------- Liquid Depth ------- Capacity _Type _. �_____ Material No.No. Compartments ------ ------------ Distance to nearest: Well ------ - -a .--------Foundation __1 -_ ____ Prop. Line __ -.--------.______ LEACHING LINE [ ] No. of Lines -- ------------------ Length ofyhach line------------------------f------ Total Length ---------------- --------_ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- Distance to nearest: Well'--- __________________I Foundation ------------------------- Property Line ----------____----_�❑ � SEEPAGE PIT Depth ------------- Diameter ---------------- Number -_ ------------------------- Rock Filled Yes No �.. Water Table Depth -------------------------------------------- ---Rock Size -------------------------------- - - Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----.---------------- REPAIR/ADDITION(Prev. Sanitation,Permit# ---------------------------=---------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------------------------------------------------------------------------------- -------------- --- .----: il Disposal Field (Specify Requirements) ---- --------- Q-� '----- _ p .tel --------------------------------------------- :i ------------------------ -------- ---- ------ - J(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 Jolt in--- 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: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such mariner as to.beco ;subject to Workman's'C pen sation laws of California." Sign IT S .-�c _eA>----------------------------•---•- Owner 17 By --------------- ------------ Title --------!✓'.G ?-r�c �-------- -----------= - ---------- { ° (If other than owner) f FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY IAkU' VMX DATE _------------ �Z = BUILDING PERMIT.ISSUED ------------------------------------------------------------------------- DATE - -- ADDITIONALCOMMENTS ---------------------I---------------------------•------------------------------------------------------------------------------------------------------------ . a ------------------------------------------------------------------------------ 7�� --------------------- g --------- — Final Inspection by: �• -------- -----------------------Date : - --- 5AN JOAQUI LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M