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s FOR OFFICE USE: ro\ APPLICATION FOR SANITATION PERMIT =------------------------ `: Permit No. -_�9-_ O� ._� (Complete in Triplicate) -------------L__ This Permit Expires 'Year From Date Issued Date Issued --__ 7 --------------------- ' ---- ------------ ----------_- - 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: JOB ADQRESS/LOCATION _��_ - ��FQ _ . meq ._ -:---.CENSUS TRACT ----------------------.--.. /KZ' a Owner's Name -------T_vi-��------��.S.l-'-��-�----------------------------- ------ �I�/- -_-- ---- -- ------PF►one�---------��--�•--------- Address --�� ®P1PP.��_ �i9� 71€� --. Cit k14 - --- _ CgL/ ------------------------------- - 3 ` Phone :- cSJ� Contractor's Name ------------------License Installation will serve: Residence 14<partment House❑ Commercial❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- _ Number of living units..---/_--_ Number of bedrooms _____Garbage Grinder �__ Lot Size -�11'-A :s_ Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loamy Hardpan E] Adobe El Fill Material -1�-- -- If yes,type __________________________ U , (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'[ ] Sizel�'�_/r X_/T� ._____- Liquid Depth .______ .__-_____ V Capacity 1. 9_Q_____ Typ _:-_: r�B___ Matericia No. Compartments------------ Distance _____ _____Distance to nearest: Well > O_____________________Foundation Z ------------ Prop. LineZ04�---_ ____ ; LEACHING LINE [4r."'No.- of Lines ----/-----__----- - Length of each line----�n ________________ Total Length 'D' Box ------------ Type Filter Materially -CA—-----Depth Filter Material /-�____--_-___R,� __________r ------- Distance to nearest: Well _ll '-_fJ00--- Foundation/�----___________ Property Line ------------ SEEPAGE PIT [ Depth _4g.r....... Diam�fier Number _____________________ ______ Rock Filled es '[�No i❑ Water:-Table Depth _ ______��__ ________________ Rock Size _ �_.___-_ �.�,. Distance;fo,nearest: Well -------------------------Foundation Prop. Linel;��4?�...._...__ ✓ REPAIR/ADDITION(Prev. Sanitation Permit# ___________________________________________ Date _____--_ ____------------ Septic Tank (Specify Requirements) --_'1,�----------------------------------------------------- -'� Disposal Field (Specify Requirements) --fSTP_Y ______ S^____w "7P1.._____ �_____S -'_- ------- - ri 43 - ----------------------'------------------------------------------------------ =------------ - (Draw existing and required addition on reverse side} I hereby certify that I have prepared this application,a4,that the 'work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulati$ns of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following,,_ � ' „ "I certify that in the performance of the wolc.for_whiih 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 , - -- Owner Signed - -------- ------ --------- - - d�+'J + - Title� " ---- (If other Onowner] I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _� 1_-. � ----------------------------------- . DATE ---------------- BUILDING PERMIT ISSUED --------- ------------------------------- DATE --------------------- ADDITIONAL COMMENTS -- - -- - ------------------------------ ---- - ------------ -------------- = ---------- ---------------- ------=------------------ --------- ---------------------------------------------------- -------------------------- -------- - -------- - ----------------------------------------- ------------------ --------------- --------------------------------------- ------------------ --------------- ------------------- ----- ----- --- -------- - ----------t----- -- ------ - - - - ----- - - - - ----- - - -- Final Inspec Date = ` ----------------------- --------------------- SAN JOAQUIN.LOCAL_-HEALTH_DISTRICT E. H. 9 7-'68 Rev. 5M�