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FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT ---------------------------------- 7� 799 (Complete in Triplicate) Permit No: ____. " . t------------ This Permit Expires 1 Year From Date issued Date Issued __- -_9"7?� Application is hereby made to the San Joaquin Local Health District .ford permit to construct and install the work herein described. This application is made in compliarice withCountyOrdinance No' 549 and existing Rules and Regulations: y i ----------- -----CENSUS TRACT ------------- :.. JOB ADDRESS/LOCATION .._._ y� / Owner's Name { , fl 3� -�' 1 'I Phone .��.3�- & -- - ------ -- Address ----- ----------- ----- � �/e-------- - ---------------•- City -----/ � -------------- Contractor's Name -.- s_- -.&_714a�/�--�---5;P,.,eI/--------'----.License #ll =.- - -- -- Phone Installation will serve:: r Residence{,''Apartment House ❑ Commercial ❑Trailer Court i- Motel Motel ❑Other __ __-_L7�SC �' /� 1 ��IVumber of living units:_--__ __ ._ Number of edrooms _.'.'~____Garbage Grinder _ ✓O--- Lot Size ------ Water Supply: Public System and name ________________________ 1 ----....-----------------------------------------------------------------------------Private 8 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 1 I� Hardpan ❑ Adobe-❑ 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,) � t PACKAGE TREATMENT [;] SEPTIC TANK'[ ] Size--------------------------------- -------------- Liquid Depth ------------•------------- i - - �"-�."�.^"a'...�r`—aa..e��+�-+:�.�--mss.-u��•. Capacity _E�----------------- Type - ---------------- Material----�_____ ____-_._--- No. Compartments _`fir.-----•-=---- , --- - Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line _______________ V LEACHING LINE [ ] No. of Lines ________________________ Length of each line__________-_..__a•___.____ Total Length 'D' Box ------------ Type Filter Material --._ ------------Depth:.Filter Material ____________ - ' -------------- ------ Distance to nearest: Well --------------------_ Foundation Property Line --------------------- SEEPAGE ______._-______ _..SEEPAGE PIT [ ] 3 Depth ____________________ Diameter __________ Number ----------------- ____ ' Rock Filled Yes ❑ No ;,0 — �F Water Table Depth ------------------------------------------------ .Rock Size Distance to nearest: Well ----------------------"___-__________.__-Foundation __:__ -------------- Prop. Line .......------------ REPAIR/ADDITION ________- ...REPAIR ADDITION[Prev. Sanitation Permit# ___ _�9,�e___-_--_________________ Date„__ ____________._________.________} Septic Tank [Specify Requirements] ------- -- --- ® --- -��:°__- � - -i`C-- �jir# -� _� �' _ �1S �} Disposal Field (Specify Requirements) - ._._� _ 3____ ___ fk _ E -v �! --------- ------------------ ------------ - -- {l1raw exis ing and required addition on reverse side) I hereby certify that I have prepared this application and thaf' 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 ken- 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 Compensation laws of California." Signed ---- -------- Owner ------ ----------- - -------------------- BY ---------------------------------------- -Title ---- - -------------- --- ----------------------------- [I of er t an , FOR DEPARTMEN USE ONLY APPLICATION ACCEPTED BY DATE 17 ` _:.,._ a ---- BUILDING PERMIT :ISSUED '. ------ DATE -------------- - '.r ------------------ --------------NAL COMMENTS .------------------- - --------`=--- ------------------------------- --- - ---- - ---------------------------------------------------------------- ---------------- {� _ ., P y-- ---- ----------------------------'�------ �` Date __..,7-'_.:=_2�' --------------- ------------------------- ; ---------------------------------------------- ---- ----- -- -- -- Final Inspection b ------------`- --------------- SAN JOAQUIN LOCAL HEALT 1STRICT E. H. 9 7-'68 Rev. 5M t:�f