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FOR OFFICE USE: _. �o i1. T APPLICATION FOR SANITATION PERMIT �Q- tj32� le, ! - Vermit No= ------------------------ i; (Complete in Triplicate) _ -- •----- --- --------------------- ------------- 77 Date Issued _7�� .-!. ------_-------__----------__ --------------- 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 compliance with County�Ordinance o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N I -- :--- 4--------- -----CENSUS TRACT ____-/ -----•----------- F.-----A-0----- 1� Phone. y . Owner's Name ----- f''s ' - - --- - --------.------------- Address ---- -- City -- - � ------- ----------•---- Contractor's Name ------- ---- -- ----------License # �f �/----- Phone 7 -- - -47 ---- --- Installation will serve: Residence KApartment House'❑ Commercial;❑Trailer Court ❑ Motel ❑Other ---- - ------------------------------------- Number of living units:---/----- Number of bedrooms -5 -_Garbage Gr• r .- Lot Size ________----------------------------------- Water Supply: Public System and name ___________________ "�4+e----------------------------------Private ❑ Character of soil to a depth'of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,E] Clay Loam ❑ Hardpan ❑ Adobe' Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of lot, location of system-in-relation-to-wellspbuildings,---etc.-must 4-be placed on reverse side.) h' NEW INSTALLATION: (No`sep.fic tank or seepage pit permittedt'if,public sewer-is available withi-n,,200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size---------------- ' -------- ----= uid Depth ------------------------- Capaci;y- ._ k,` _ ,: ;.Type -- �---------------- Matefial � No. `Comp,artments V Distance to nearesfi:" Vell -----------------------------_______Foundation _.._.-__ - --* Prop brie ______________.------ LEACHING LINE [ ] Na,.of Lines __ - - Length of each line--------------____--.------ To#al Length`!_ __.--_.__-______----- 0 . jD`. Box __ '*',- ` Type FllterWaterial ________________.Depth Filter Material ' ---------- ____,.__----__------ ..r.. Y ;4- -- 4i`Foundation Property Line ___ _ _____________ Distance'toneares#;Well - f_=_� -- ---- - p tY " r: F SEEPAGE PIT [ ] Depth ____________________ Diameterr___L-``rt_ �Number .____.---------________-_- Rock Filledl Yes ❑'� No ❑ i . i N Water Table Depth ' ___Rock Size -------------- ------ - __ _ .--- I Distance to nearest: Weilt------------------------------- ------Foundation ---------- •------- Prop. 'Line --------------------•- REPAIRJADDITION{Prev. Sanitation Permit# --_ ------------------------ -- Date -------_____- Septic Tank {Specify Requirements] _ i ------- /� ,, - Disposal Field (Specify, Requirements) __------ - ----- --- Q----`--;- I - ---- t � --------------- ----r x -s P , 1 � I ------------------- - ------- -------- ----------------------=-------- ----------- _may_,-------- --------------------------------------------- (Draw ekisting and required addLifionjon reverse side �o 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. Horne 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 shal not a "ploy any person in such manner as to become subject to WOTkman's Compensation laws of California." Signed ------------------ - ------------------------------- Owner ��, r+r By _... ------ F ----- ---------- ----------------------------------- Title -------`-'cC.� (If r than owner] t O ARTMENT USEFONLY APPLICATION ACCEPTED :BY ------ - --- - -: - ---------- -------------------------------------- ---------------- DATE ---------------- BUILDINGPERMIT ISSUED -------- -- -- ---- ---- ----- --------------------------------------------=--------------DATE --•--------------------- ----------- ------ - - ' A---D--.D--I-T-�ION-�_9_LCOMK'ENTS'----- -i- - ----------- - -------------------•----- ________________________________________ _________________________________________ -----_ 3.. /~I __ _____________ __ "w 'I ---------------------.------------------------------------------------------------------------------_------------------------ ---------------------------------------------- --------- _ ____-_-___________________-_________--________-----______.____-_____-__.___------------ ------ ___-______._._ Final Inspection by c,�., -- ---- -- ------- Date � � JOA QUIN LOCAL HEALTH.-DISTRICT E. H. 9 1-'68 Rev. 5M