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- !FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 I - ----------------------------------------------- Permit No. + (Complete in Triplicate) _____ _______________________________.___--------__- 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. 549 and existing Rules and Regulations: 10B ADDRESS/LOCATION .-_._-._ _G 'f ��' s - CENSUS TRACT Owner's Name _ c -)-/-------------------------------------------:.•------------------_Phone Address -------- �-� `'= ----�� ) i ` fc1� ' ------------- ---------- City = _ Contractor's Name _-._�_�C�:: '•r-`- ,=C-CL=�--=- 1 ,_[�_---/_r�_Y�_ _'License # ' - { -- Phone �f _ '/ 1 �` Installatiorf will serve: Residence ®'Apartment House-❑ Commercial ❑Trailer'Court Motel ❑Other-------------------------------------------- Number -- ------------------------------- Number of living units:--____ _---- Number of bedrooms _ ______Garbage Grinder ___.________ Lot Size ___ !/-`__ ___ ------------- Water ___________Water Supply: PublicSystemand name ------------- 4--------- -----------------------------`-------------------------- :--.-----Private 1-71 Character of soil to a depth of 3 feet: Sand❑ Silt❑ r Clay ❑ Peat ❑ Sandy Loam❑'; Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If Yes.type�_n--------------------------- (Plot - ________`--------------(Plot plan, showing size of lot, location of system in, relation to wells, buildings, etc. must be placed on reverse side.) PACKAGE INSTALLATION: (No septic tank or seepage pit permitted if publicle. �sewers available within 200 feet,I j f Q TREATMENT [ ] SEPTIC TANK Size:___-- -Il _ ___, ^.!_ __ --- 'qDepth __---),-ref Capacity 11—el-� lType , ,_ Material pX1 't(_ r P_ No. Compartments __--- Distance to nearest: Well ___ 1___ d4i'll' ___Foundation _.__-, �J_r.___ Prop. Line ._,..-. :. ..... LEACHING LINE �( No. of Lines ---------/-------------- Lengr eac 'n ----.-- ----- Total Length .___f�!�/�__________- 'D' Box ---- -L--- Type Filter Materi _ f_. __De th filter Material _-_ yp -, = P `Distance to n6drest' Well undation' ------ CJ--- _- Property Line __l =_ ------- SEEPAGE PIT Depth ------ Diameter _44 ---_ Number ----------J----- -------- Rock Filled Yes [K No i❑ ,e i Water Table Depth,.___________---. __________Rock Size ----__. _� -------------- ------- ----------- -T Distance to nearest:,Wel1 ;._:-_�-1_----_-J____:_____Foundation __ __ __ .- _ f J /` � Prop. Line . REPAIR/ADDITION(Prev. Sanitation Permit#---+----'-_---- -'-------------------------- Date ---------------------------------- Septic Tank (Specify Requirements) = : ____-_a - ---------D-----i--s---p----o--sal Field----(-S--p--e-c-ify Requirements) �.PJc. - `:'r_ /off{(! 1 ''`J--------4-7 --'=1�//, #- - - - ------------ --------- ffrr11�, _--- 1__<_J r �'"' 'S=---- ----------- --•r'� (Y t ------- ----------------------- ---------------------------------------------------------------------------------------------------------- (Dra -- -- (Draw existing and required addition on reverse side) . ;,L. 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:, "1 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." Y .. =.................' T ---------------------- Owner �� . , r ( Title -- 'G� f : Signed (If other than owner) OR TMENT USE ONLY APPLICATION ACCEPTED BY ------- I ---- - -- - - - - ----------------------------------------------- DATE BUILDING PERMIT ISSUED ---------- ..._ DATE A DIT ONAL CO TS 4 ------- - - --------------------------------- ---------- -------------------------- --- - F�_1�cs �'ran -��, -6------ � ---------------- --------------- --------- ------ ----------------------------------------- -------- :, --- Final Inspection by: ------ ------ --- ------------------------------------------------------------------Datef.^ SAN OAQUIN LOCAL HEALTH. DISTRICT .� E. H. 9 7-'68 R