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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT � ................................ Permit No:....-..... t o �• (Complete in Triplicate) - - �. . .........................!'-..-- T . �_ !' .: -q-.. ..---�.:.....................................•....- ..... This Permit Expires I Year From Date Issued Date Issued ./.. . Application is hereby made to the'.San''Jodquin Local Health District for a permit to construct and install the work herein described. This application is mode in compliance with'County Ordfh6nce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 19I.V, -' '. �-• ar��7.G�..�1'.C-----__------------------•....................CENSUS TRACT .......................... Owner's Name .. � �f ... ! ' Y� .... Phare ............................ Address ......67110-10"11r,i------ ., City ............................ Contractor's Name .... . ��?.- �� `.:..................•..................-.License # Installation will serve: :I Residence, Apartment House 0 Commercial❑Troller Court C] Motel,E]Other ............. Number of living units:-./....-- Number of bedrooms -�------Garbage Grinder A-15-O__ Lot Size ............:.....:` I Water Supply: Public System and name _.[gip. :. '._ /1_ � ...........................................Private ❑ Character of soil to a depth'of 3 feet: Sand❑ Silt❑ Clay ❑ 'Peat❑ Sandy Loam fl Cloy Loam ❑ Hardpan ❑ Adobe Fill Material .-_----__ If yes,type •` ........................ mak, (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 ( ]i SEPTIC TANK i ] Size............................. ------- Liquid Liquid Depth .......................... Capacity -------------------- Type ----. ........ Material-----...--............ No.o'Compartments ---:.................. Distance to nearest: Well ..............................F oundation............. Prop. Line ...................... LEACHING LINE [ ] ";Noy,-of Lines g ...--_.-. Total Length `' ------------------------ Len th of each fine-----•----.._.... ............................ 'D',;Box Type Filter Material [Depth Filter Material i ............... Distance to nearest: Well......:................. Foundation ........................ Property Line ........................ SEEPAGE PIT ( J Death ..................:. . Diameter ................ Number ------------------- Rock Filled Yes ❑ No ❑ Water Table Depth ` a ' ...................Rock Size Distance to nearest: Well ........................................Foundation .................... Prop. Line ....... .............. i REPAIR/ADDITION{Prev. Sanitation Permit# w,.-•..........................•-.••-__-_-- Date .................................. ; I: --f 19 t Septic Tank (Specify Requirements) ......... ........................... ................------------- Disposal Field (Specify Requirements) �C __._. ___41A � f�,ry`, 6lp ..1. _ ______, y� ----•--.._..----- -•--- ; ----------------------------- '.L.- --------------------------------------•---...----------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 Health District. Home owner or licen- sed agents signature certifies the following- _ "I certify that in the performance of the work fog 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, ' 13y ....................... ---------------- --------------• - - Title 64, ....................................... # ...--------•-....... ot�er than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ., . .....'� -- -- -----------•..........................-.....-- k.-----._.....--..----....... DATE _...�z ... ....2.-. -••--•----a BUILDING PERMIT ISSUED !?--....... -•-•----.......-•......... .................. .......DATE ..... , ------------- ADDITIONAL COMMENTS -'— ....!., .............:........................... r ........... ..4......`..w... _-___---•_•_------tib•- E .....-..-.........................._. ' •... ---------------------------............ ----------- -•- ••---............-.........•------------------------- ----[- ----............ ...............___.....-__....._.........--..........._.._... �. , .............................• •------ .. .... .... --.......-.•-------------............-_-........-...._.--.....-..--...---_--•__•_•--•__---_---''-.._. .-.__._. . . Final inspection by: ----------------------------------•._...,........ Date .... .. ... .......... SAN_JOAQUIN -LOCAL HEALTH DISTRICT E. H. 13 24 1-'68 Rev. 5M 7172 3 �K