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` `"APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.6�r_-"_7eGo --------------------------- "--------- This Permit Expires I 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 workhereindescribed. This application is made incompliance with County Ordinance No. 549 and existin Rules and Regulations: JOB ADDRESS/LO �I CATI� --.:E'-r� .oL.__' - - -- --- ----'=`- ------- ----�-'"CENSUS TRACT _-S�"V� Owner's Name - A -------- ---- p ----- --------P one --------- - ,ks Address __ ------------•--•-•---•_-- - - ---------------------- -------------------------------- ------- --------- ' '::. Contractor's Name - License # ------- ------ Phone --------------------------------------------------------- Installation will serve. Residence*Apartment House❑ Commercial-OTrailer Court ❑ Motel O Other Number of living units:-. """_" Number of bedrooms "--�------Garbage Grinder ------------ Lot SizeWater Supply: Public System and name - `---'------------------- 1� """-"-"----"""""" --------------- - - -- Private [� Character of soil to a depth of 3 feet: Sand:❑ Silt❑ Clay ❑ Peat[] Sandy Loam .0 Clay Loan;❑ _�; Hard an ❑ - ' P ❑ " ,Adobe� Fill Material ------------ If yes,type ' (Plot pian, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) LM NEW INSTALLATION: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK f ] Size_" _" ---------------------- Liquid .Depth --------------- Capacity -.'. -------------- Type -------------------- Material---------------------- No. Compartments ------ --...- Distance to nearest: Well ------------------------------------Foundation --_-------_-_-" LEACHING LINE No. of Lines. "- --"__ Prop. Line ___._____.---_...__.-- ----------- Length of each fine.-/ "-_"""-__-." Total Length �d D' Box +"-_-" Type Filter Material '_- ---------Depth Filter Material � --------------- bistance to nearest: Well __��h ____-__ Foundation ` ---- � --��--�-----�------- - Property Line � SEEPAGE PIT p rtY No !'1 AX� `----------- Dia �� Number , e . Rock d Water epth _"/_aZ-Q r Rock 413 --------------- -------- Distance to ned s : ell "� O� Foundation "_" �� 0 ' -- ------ Prop. Line ' REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------- : Septic Tank (Specify Requirements1 __-.--------"_.._ � 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 IRules 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 sublet to Workma 's Compensation laws of California." Signed ",C ---_ --- ---------------------------------------------� caner BY (If--- -- - -- -- - - ----------other tanowner) t h --- Title FOR .DEP,ARTMKENT USE ONLY APPLICATION ACCEPTED BY_-- ----_- f - DATE ` BUILDING PERMIT ISSUED ------------- ---!___-- " ----- - ------------------ ----------------------DATE ------ ----- ADD1TiONAL COMMENTS ----- ---------- �-------------------- ------------------- ------ .�: - __ ------ -1S 7.0 �, - ----- -------- --------------- mac- --- - l- Final Inspection by: _ - -" -- -- =------- - - - - ---- --------Date -/-�-- --��D--- � - ----•-- SAN JOAQUIN LOCM- HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.