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FOR OFFICE USE: r-1 IA /� �� wG ,APPLICATION FOR SANITATION PERMIT - -------------------- -------- Permit No: --� -1 t (Complete in Triplicate) ' --------------- This Permit Expires ] 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 incompliancewith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .' - ----- - / ---------- ---------------CENSUS TR©ACT -------------------------- Owner's Name --------------- - -- - ------- /- -- ---- ----5. —A-------------------- ---------- --------Phone J-/4—*, ------ Address - ------ =-- - -- --- C --- - ------- ---- . city --- --- q r� Contractor's Name -----------_i-- - -- - - ----- ---- C ---------=--------.License # -------_-:-----:-------- Phan e�_6_---? Installation will serve: Residence ❑Apartment House❑ Commercial []Trailer Court 1❑ I Motel ❑Other --- ---------------------------------------- Number of living Lunats: __tet_.--.Number.of_bedrooms--�-Garbage.,GGrinderr,�_-----_--- LQt Size _(QQ___ �- ______________ Water Supply: Public System and name ---------------------- ------ - -- �--�, w""` -------�----------- ------Private ❑ I �` ` / f Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay Loam.❑ ; Hardpan ❑ Adobe� 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.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[,] Size-----------------------------1-----.------------ Liquid Depth --------------------------- capacity -------: ----- Capacity -----------'-------- Type„�- ------------------ Material-----------#-_-------- No. Compartments -----............ Distance to nearest: Well -____-_----------------------------Foundation ----------------------- Prop. Line --_-_ --------------- LEACHING LINE r[ ] No, of Lines ________________________ Length of each line----------- ---------------- Total Length ------------ ,---_-____._.__ 'D'::Box ------------ Type Filter rMaterial --------------------Depth ;Filter Material ------------------------------------- Distance to nearest' �______ Foundation ____ ------------------- Property Line ________________________ ., t o_ i I .�5 SEEPAGE PIT ________________ Rock Filled A Yes"'❑ No .0 [ js Depth -------------------- Diameter - =- --____-- Number -------- - - Water Table Depth ---f.A_=---Rock Size ----------------- -- --- � Distance to nearest: Well ----------------------- -------------Foundation ------------------I-- Prop. Line ...................... 'jA REPAIR/ADDITION;(Prev. Sanitation Permit# _________ __ _ ___ __ __ _.__ Date Septic Tank (Specify _ ___Requirements) R t �- --f l r Disposal Field (Specify Requirements) ------------------------------------------- ------ -------/ ---- --- -- ------------------------- -- - -- !--------------------AA------------------------------------------I---------------------------------------------------------------------------------=-==- (Draw existing and required addition on reverse side) Tr this application and that the work will be done in accordance with San Joaquin hereby certify that I have County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that iii the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subiect to Workman's Compensation laws of California." ' r Signed ---------------- ------------------ -------- ---- -----' ----"..�'--------- Owner �� ]� . By ------ -------- r�IK. Aj�er)j P--- -- R ----------------------- Title L- ` f (If opt FOVIIIEPARTMENT'USE"ONLY APPLICATION ACCEPTED BY ------ r" ~-►� x_=f`` -.-------------------------------- DATE -----74--- 1-7-T9:�-O--------- BUILDINGPERMIT ISSUED --- ------------------------------------------------ -------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS -- ------------------------------------------------------------------ ----------- ------------------------------------=--------------------------- --------------------- ------------------------------ -------------------------------- ---------------.--------------------------------------------- -- ------------------------------- ------ -------------- ------------------------------- -Q9- -- ;ep--------- = ----- Final Inspection by: -------=---------------Date _. --- - ------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M