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i-OR OFFICE: USE: APPLICATION FOR SANITATION PERMIT 'i --------------------- Date -- ------------------b-=-- "- Parrnit No. (Complete in Triplicate) Date Issued �`��r""_. -------------- ------------it-=--z� " --------------- "____.__________ This Permit Expires 1 Year From 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 c lancevyith County Ordinance No. 449 qra, e, isting Rules and Regulations: JOB ADDRESS/LOCATION .: ......... _ _ _ �y/y� - --- -----------------------CENSUS TRACT ------------------- Owner's Name .... � -Irl----�------ --- -----•-- ------•------------------------ Pone Z Address -------- City - Contractor's Name ""__ __-.License #rtQ_ � 'f Phone-- -------- Installation will serve: Residence XApart ent House-E] Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:----- Number of bedrooms _____Garbage Grinder --- Lot Size _27S-0X/ ..___._... WaterSupply: Public System and name ---------------------- -------------------------------------------------------------------------------------.-Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam C1 Hardpan ❑ Adobe 0 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,] PACKAGE TREATMENT { ] SEPTIC TANK( 1 A'�e------------------------------------------------ Liquid Depth -------------------------- Capacity __-- No. P Y - ---------------- Type ---- -----------.___ Material-------------- - Compartments ---------I......... r Distance to nearest: Well __________________________________Foundation _.-------------------- Prop. Line ____________.__.__..-_ LEACHING LINE No. of Lines ----- Total Length ---------------- r , 'D' Box ----/-___ Type Filter-Material "/14____ _______Depth Filter Material ___ _---____.___-_____ r -------------•- r� Distance to nearest: Well _ found ---�a ---------- Property Line ---ation �____ ____._�� SEEPAGE PIT Y[' Depth __c2-5------------ Diameter _______ Number --------------- Rock Filled Yes & No r f Water Table .Depth -------A---------------------------------------Rock Size ------------------- Distance to nearest: Well 22.4`CcJ ""_________________Foundation -Z0_ _____"- Prop. Line _" ...__.._.....__.. REPAIR/ADDITION{Prey. Sanitation Permit# __------ ----------------------------------- Date _________________________________) Septic Tank {Specify Requirements} ______1-1;r'c-A ��_____7 _____e'k f-So � G" [ 'e Dis osal Field (S ecifY Requirements)' __ , ! __-__- __________________________.__ ___________- �O------- _r --------- -------------------- ----------------------------- - ------ ------------------------------------------r---------------------------------------------------- (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 Wealth 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 such manner as to become subject to Workman's Compensation laws of California." Signed ----------------------------------------- Owner BY � �— Title . ' --------------- ---- ---------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... --- -- -- ---- ---------------------------------- DATE � {�...... BUILDING PERMIT ISSUED ---T ----------------------- ---------------------------------------------- --- ---DATE ------------------------------------------- DIT ONAL COMM -- --- - ----__ - ------------- ------------- ------------- ----------------------------------------------------------------- _ ____ _` ...-r_ _____________ _____ ______________"-"_-_____________--__- _ _____ _- ____-______-____-_______ -------------------------------------------------------- _ _. _ _ ---_-------------__""-_ Final Inspection b Date __ - 0----------- �QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re . 5M