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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �- �. Permit Na. -7S` 63.5 [Complete in Triplicate) t ; Date Issued -�Jr This Permit Expires 1.Year From Date issued --------- ---- Application is hereby made to the San Jo quiri_-'Local-Health District for! a.permit to construct and install the work herein described. This application is made in compliance with`Courity Ordinance,1;. 549 niiJ existing Rules and Regulations: JOB ADDRESS/LOCATION _- - --. -------e ------ ._ CENSUS TRACT Owner's Na } _I_ -1144Zll__:._St'>C .- ----PhoneIN . - Address c� _ i �,5' _ city _��,y L r/�Jb1 ' =- ' i License # _' '�/�' _�a_ Phone Contractor's Name . ______ '� ? # i s ; V Installation will serve: Residence 50,Apartment House❑ Commercial:❑Trailer Court ',❑ if..` _..� er of b❑edroams -- --------Ga---�-------------___::__� �. cl .vlv\.�' Motel Other - Number of living units �'_ rba } `�_ Nu b .� ge�Grinden..-ii-�----- Lot Size ----------•------------------ -------------- ------------- ------------ ' ' 1--------------------- Private [ Water Supply: Public System and name ------------' --------------- '--- -- i - ,^ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑F�Peat E]'- Sandy'Loam ❑ Clay Loam F. Hardpan ❑' Adobe .l] . Fill Material -------- If�yes,type (Pl'ot plan, showing size of lot, location of system in relation to wells,�bu4ldi,ngs, ;etc, must be placed on reverse side.) NEW INSTALLATION: {No septic tank seepa " pit'pernitted if ublic'sewer is dvailabPe within�200 feet,) r r PACKAGE TREATMENT [ ] SEPTIC TANK'[ : _ _ Size-;' ___-''y _"'. ____„” -- ------ Liquid Depth ----- ------------ X d �� Cap .itY � :©- _-""-- Type -_- ---- ----- .'Material_111/mo-- No.� Compartments --- -.----- �stance to nearest: Well' ��Dl_"___. } ---------Foundation ---eV---rh___ Prop. line ______-- -- LEACHING LINE [ No, of Lines - ---------- # _-r_ .__ Total Length f. .Length ofeach line-- 'D' Bo t__ Type Filter Materia[ �_�__!_________Depth-Filter�Material _-__.��-------__________{.....--.---- Distance to nearest: Well ____1049---_----t--:,Foundation _ lf_ - Property Line. ._------ ....-...._._ Jr ' � Rack Filled Yes No;. SEEPAGE PIT [ ) Depth ---_--------------- Diameter ---------------- Number t--------------- ❑ ❑ ;Water Table Depth --------- _ -- •- Rock Size ----------------------- - ' - - - -----�"-._ t - Prop. Line -_------------------ REPAIR/ADDITION .-•---------:--• -• Distance to nearest: Well __________"_____________________""-- --Fo�undation - -_-:___-"-. REPAIR/ADDITION(Prev. Sanitation Permit# ---5-- - ----------------------------:------ Date __________-- ________-.------:-_.-) /f-Septic Tank (Spec#y Requirements) ;N ------- 2_ --- S �, incl-�., s_ _ Disposal Field (Specify Requirements) _____ ________ ::-- --- --,--y-�--- a ! 1- -•-- --- �� _ /r ----------- ----------•-------------------------- =---------------- l _- - - {Draw existing and required addition on reverse side) • I 1 hereby�certifyj 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: "I certify that in the performance of the work for which this permit is issued, I shall not employ any=-person:in-suchimanner as to become subject to Workman's Compensation laws of California.". I Signed Owner BY ----------------- ------------------------------------------------------------------------------------ Title -- ----------- ------------- --------- ---------=--------- - (If other than owner) FOR DEPARTMENT USE ONLY ` APPLICATION .ACCEPTED BY _- [ ��__ _ _.: . _: :, :_ DATE ----- - _- ----. BUILDING PERMIT ISSUED - - ------ - - ------- ------- ------ ------------- - _ _DATE ` ADDITIONAL COMMENT -c-.",".�----- =A= �~'------ °` -------- "' '�------------------------------------------------------------ --- --------------------------- -------------------------------------------- --------------- - ------ ----- ------------------------------- -------------- ------- ------ ---- - ------------------------- ------------------- Final Ins _ Datef - t -- ----- ----- ---•---------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M