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FOR OFFICE USE: 7� APPLICATION FOR'SANITATION PERMIT (Complete in Triplicate) Permit No. -Z/J___---------- ------------------------------------------------------ This Permit Expires 1 Year From Date issued bate 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.Coounty Ordinance No. 549 and existing Rules and Regulations: , rf ,.$.� - -------------- ----- CENSUS TRACT ----- - ----------- JOB ADDRESS/LOCATION �� -----� %`�K------- Owner's Name ------- --- ------- -------- --------------- ---------Phone Address ----------------------------------------------------- ----- ---- - -- -- -- ------- CitY . =-• --------......- `I Contractor's Name -------- ------- 64-----------------License # - l_'r_ _ Phone r :�An4_/- Installation will serve: ResidenceoApartment House❑ Commercial :❑Trailer Court io Motel ❑Other -------------------------------------------- Number --- -------------------------Number of living units:---- Number of bedrooms ____._Garbage Grinder ,r1®..... Lot Size -------- Water Supply: Public System and name -------- ---------- '' `I------------•-- ------------------------------------Private ❑ , Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam 1] 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 reverseside.) NEW INSTALLATION: (No septic tank or seepage pit permitted.,if public sewer is available within 200 feet,) + O PACKAGE TREATMENT [ ] SEPTIC TANK [ ] ,�lSr, ' e`--------------------------w------------------ Liquid Depth -------------------------- Capacity --------------- -- Type ---------------- -- Material-------- --- No. Compartments .................... .- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING ------._------.-- -----LEACHING LINE K No. of Lines -------- length of each line.......L'/' -Q___r------- Total Length ____moo........ r -D' Box AA ___._ Type Filter Material � ---_--'Depth Filter Material ____ `_(_.______________________ Distance to nearest:.Well eV - e- Foundation -/0--e-------_--_ Property Line �� ---- Rock Filled Yes ,No _____ Diameter �_�_�`__ Number ._____ .____ SEEPAGE PIT �' Depth _�_� _. ,� .__--._ -_- ,�` ❑ Water Table Depth --- -- ___Rock Size ____A---__ Distance to nearest: Well . ___ 'f -- ----------Foundation ... Prop. Line ------"5--..__........ f t REPAIR/ADDITION(Prev. Sanitation Permit -------•------------------------------------ Date ------------........--------------] SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ------------------------ _--------------------------- Disposal Field (Specify Requirements) ------- _-�_ +_____ C --------------------------------------------------------- - ��_- --------------------------------------------------------- - ------------------- - (Draw existing and required addition on reverse side) i 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 "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." i Signed ------------------- ----------- ------------ -- ---------------- Owner ' f BY � _ --------- Title ------. f , ' . (If other than owner) / 'FORD TMENT USE ONLY APPLICATION ACCEPTED BY ------ - ------ -.--=-----------------------------------------. DATE r" --------------- BUILDING PERMIT ISSUED ----- -- - ------- --- --- --/e7 ------------------------------- -----------_._DATE ------------ ------------------------------ i -- --- AD ITIONAL COMM T 7� ------------------------------------------------------------------------------------------------------ --------_- -- ---- =- - ----- ----- ---------------------------------------------------------- ------------- -------------------------------- ------------------------------ ------------ - ----- ---- ----------------------------------------------------------------------------------------- --------------------------------------- ----------------------------------------------------------------------------------- Final Inspection by: ----------------------------------------Date -7 -------------- SAN AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re t