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FOR OFFICE USE: APPLICATION FOR,SANITATION PERMIT ----------------- ------- ----- �. Permit No. _ '�-- _ {Complete in Triplicate} --�-- •.. .a_ _ i__ _ 7 fC Date Issued 9L,2,2,67 ------------- F ----_------_-_----------- This Permit Expires 1 Year From Date Issued Appllication 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 Ord —549 and existing Rules dReReg�tions: f� t �Aj ! c. X -- VSE , �'�'60 C��`1-- �„ SUS TRACT = - JOB !ADDRESS/LOC TION A --. - ----- --- Owner's Name -- 11�1r r / - Phone 071_/_/P W-va=X-----------__ City _ s1 -------------------------------------- ------ Add ess --------------------------------- --------------- --•_----- ��i Cont€actor's Name Q �� '-------------------------------- Licerise #�� 5a- PhoneZ G= Installation will serve: Residence U.�Pclrtmerit House f-] Commercial'[]Trailer Court ,❑ Motel [] Other ---- ------------------------- ------- ► Number of living units:_-----)---- Number of bedrooms 2-______Garbage Grinder-? :&.!i--- Lot'size _ -- ------I Supply. Public System and name --------------------------------- -------------- -----------; - ------------------------------------- Private er' Character of soil to a depth of 8 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ ; Adobe ❑ Fill Material .A119 If yes,type _____ _____________--__-- ; (Plot .`plan, shcsw"`'s g side of lot, location of system in relation to wells, buildings, etc. .must be placed on reverse side.} ' 1- NEW INSTALLATION? (No septic tank or seepage pit permitted if public sew r is availal5le within 200 feet,j 1 +D PACKAGE TREATMENT [ a SEPTIC TANK [ Size�_.._ _ _ -�( --------'-- ------ Liquid Depth - 1yZ.�_-___------ t Co' acity _�-�f!'�------ Type -�vXt--- Material_ r- No. Compartments __c .�-:_------•-- �, R s Distance to nearest: Well ----- j___________________Foundation ....�_�_........... Prop,'Line ___S -------------- ( Lin � D- -------- Length ------------Total Len LtI t yy77�� `D' Box _)p_.&__ Type Filter Material � ��'t2-Depth Filt terlulaterial __ _ ___________________ _•..-f.-,_--- Distance to nearest: Well _ ________________ Foundation _ ____-.-_-_-._.__ Property Line. .- SEEPAGE PIT Depth --------- Diameter : _`_____._ Number ,____ ----_------ Rock Filled Yes No .i❑ Water Table Depth -------[o ---------------------------- -Rock Size l L ---------------- Distance ------------- Distance to nearest: Well ------/.,0_Q-------------------/__Foundation ___ _ ___________ Prop. Line ______-___-_____-- A REPAIR/ADDITION(Prev. Sanitation Permit# +-------- 9.=cam_---------------lDate ; Y, _-----_�___j-- ` Septic Tank (Specify;Requirements) -----------------A------------------ -- ----------------- --.. ------ ---------------------- ------,..--------------------�---- Disposal Field (Spec fy`Requiretnent'js .-----------:--------------------------------------------5-?-------------------------;� ------------------------.------------------------ { ---------------------------------- S ' -- --- ------- --" ------ --' ----'F-- -- (Draw existingand 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. Homeowner. 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 subject to Workman's Calm pensation,Iaws.of,Californio." iSigned ----- ---------- ---------------------------------------- Owner .}�. i BY '`'''"' ------------------------------ Title '!`-�^-� E # { f other than owner) r FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY ....... DATE _-__--` '------- : BUILDINGPERMIT ISSUED --------------------------------------------------------- ---------------` - =---------------- -------DATE ---------- ----- ---------- ADDITIONALCOMMENTS - ---------------------------------------------- °------------------------------------------------------------ - ------ --------------------- -_-------------------------------;-,-------------------------------------------------------------------- --------- f ------------------- ------------------------------ t Final�lns ection b � � SAN JOAQUIIv. LOCM, HEALTH->j ------ ------ ._.... �--�,--�-��-----1...- -- -- - ------------------------------------------------ P Y-- -----.---- ----------- - Date .. _..•. _t DISTRICT.., r E. H. 9 1-'68 Rev.'5M"