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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ L/_---------- 6. RC1------- Permit No: (Complete in Triplicate) --------=---- --------- ----------------------------- �j/y Date Issued�_--.r-�S!_-�7J` --------------- This Permit Expires 3 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION _ Qcr --- �__ /�' L�'� ------------------- --_--CENSUS TRACT -------------- ----------- Owner's Name --- �/� 2 - - - --------------------------------- -------- Phone Address --- --------- --------------------------------------- City -==---------------------------------•------ Contractor's Name ------- �-!(7 ' P/ !"-----------------------=--------License #� _ ��' Phone -------------------------•---- Installation will serve: Residence Z Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other ------------------------------------------- � f � Garbo p Number of living units:-_.-/____- Number of bedrooms -_______ ge Grinder �- Lot Size ra_�X-�`�--^- -- -� Water Supply: Public System and name --------------- ------------------------------------------------ ---------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam;❑ _ t Hardpan ❑ Adobe X 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) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK;A Size- -, - ----------------!--Liquid Depth Capacity� � _-____ Type «- - Material_Cull n�,- Jl No. Compartments --------------- // LL A Distance to nearest: Well -_ ?_f-T-................Foundation /,�-------------- prop. Line -- ....._.s f LEACHING LINE No. of Lines ___ Length of each line___�P----------------- Total Length oZA0------------- Depth ----------------- 'D' Box' 4l,9_ Type Filter Material A� G3'�-.Depth Filter Material .� -._--------r�.-s Distanceto nearest: Well - �' _�_--------- Foundation p---------------- Property Line _4_-______--___._.... SEEPAGE PIT [ ] Depth _ Diameter _______________ Number --------------------------- Rock Filled Yes '❑ No .0 WaterTable Depth --------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------...-----._----- REPAIRfADDITION(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 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 emiiloy any person in suchfmanner as to become subject to Workman's Compensation laws of California." i Signed -------------- --- _ Owner :T` By ------- ---- -- ---------- Zee- /--- ------------•----------- Title --- e =------ ----------------------------- (If er than owner FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY --- ---------------------------- -------------------------------------------------------- DATE ------:w--------7- ------------------- BUILDINGPERMIT ISSUED ------------------------------------ -----------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------- ------------------------------------- --------------------I-------------------------------------------------------- -------=----------- --------------- ------------------------------------------------------ -- --------------------------------------------------------------------------- ------------------------------------------ --------- - -------------------------------------------------------- ------------ ---------- - ---------=------- - - Final Inspection by: ----- ---------- -------- ----------------------------------------- ----- ------Date ------------------ SAN --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M: "