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FOR OFFICE LISE: APPLICATION FOR SANITATION PERMIT ----- (Complete in Triplicate) Permit No. -----------------------------------------_--------------- 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__._1-J q7--,_rte___._'_._ ------------A _--CENSUS TRACT __.--6--_----•---•.---- Owner's Name --------- ] CyQ �� tt1L�� 'f.C? a------ -------------Phone Address ---- -------) �f 48E-E7- -------- ------------_. City ---AIANTIEClq------------------------------- Contractor's Name Ccl=0— Qs------ --------License # �; - -- Phone _2 '�_s Installation will serve: ResidenceET�_partment House❑ Commercial ❑Trailer Court ;❑ } Motel ❑:Other --------------------------------------------- Number of living units:----(.___._ Number of berooms ___---Garbage Grinder 1`f_l1__. Lot Size ---O>M__K__1_Z-L________________ Water Supply: Public System and name ------------------------------------------------ --.-------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑AA rr Sandy Loam m ❑ Clay Loa "' Hardpan E] Adobe ❑ Fill Material .(-5�.®___ 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 seep pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK'[ Size__--`f-- A l0--� _____________ Liquid Depth - � , , ------ Capacity _____Ca acitY -Q---�-- TypePtlfE-__FA_ - MaterialNo. Compartments, . V istance to nearest: Well --------- ____'�_._________Foundati n ___ Prop. Line _ �_" ------ LEACHING LINE [ No, of Lines .___ - Length of each line_________________ ___ Total Length ____� t �.._........ re, 'D' Bo 1__7_5 Type Filter.M�Maaaterial (��' ! __.Depth Filter Material ______ __ .....:. .......,. ____....__-_ Jr Distance to nearesta Well -.1 -___ __._-_ Foundation ______________ Property Line. _ --_"f--_^_-___ SEEPAGE PIT [ ) Depth --------------------- Diameter ------------- Number __----------_--------------- Rock Filled Yes ❑ No i❑ :.n i1�Vater Table'Depth --------------------- -------------- ---•--..Rock Size ---�------- ------_----------- _ _ -Lpistdnce to nearest: Well ----------------------------------------Foundation -------------------. Prop. Line.-.-------------•...... REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- ---------- _-.--- ` ' -- Date --------- `.................�--) Septic Tank (Specify Requirements) ----------------- R ___�._ _-- _______________._-_ ------ 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-employ any person in sfuih manner as to becsubject to rknian"s mpens oati.on laws of California." Signed _---q -----r1 l Owner BY ... - ------- ---------- Title (If other than owner) # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . DATE I �---------------------------------------------------------- ----------- - BUILDINGr — PERMIT ISSUED ----------------------------i------- . --- :: :• : :---,-.-:--:-:----- --------------DATE -------------------------- ----------- ._. .. _ . ADDITIONAL COMMENTS ---------------------------- ---------------------- - - - --- -- ------------------ -•----•----------- - --------- --------- -------------------------- ___ __ Fes___. ___•_ l Final Inspection Date _________ ____ _ � � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M