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FOR OFFICE I-ISE: APPLICATION FOR SANITATION PERMIT -------------- ---- - ---------------------------- * Permit No. (Complete in Triplicate] -7.1r-I f `o --------------------------------------------------------- This Permit Expires 1 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --- ---�I _ -------1i_ aV------------------------CENSUS TRACT 6_761--------- Owner's Name -------------------------------------------------------------------- -•------------------ Phone ------------------------------------ Address -- --__�n__-----`---- Cit -- Contractor's Name --------------------------------------------- ------------------- License # ------------------------ Phone --------------------------•--- Installation will serve: Residence Apartrnent House(] Commercial ❑Trailer Court ;❑ Motel ❑ Other == _— --- t Number of living units-------J-___ Number of bedrooms ___....Garbage Grinder ...... Lot Size -------?------------------__________________ Water Supply. Public System and name _____J!ac&I, _.rue..44�41--- ---------------------------------Private ❑ � Character of soil to a depth of 3 feet: Sand' ilt❑,' Clay ❑ Peclt- Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe;❑ Fill Material ____ ___ If yes, type -----------i---------------- + (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 seepa pili permitted if public sewer is available within 200 feet,) ` c f `/ ul a PACKAGE TREATMENT [ ] SEPTIC TANK' r 5ize--_�__X-� �_._______._____ Liquid Depth ___________,�_____...._. �► Capacity .CA_fw----- Typkv'"!�:-_ Material C.GW_e_ e No. Compartments __ --------------- Ir 4 �`//191. tale, Distance to nearest: Well rid�__ __ ___________f,,Fouridation __1d_------------- Prop. Line -LIr=�i•I }6-Eli [ ] No. of Lines _________f_____.____4 Length of each line------ ____.------ Total Length�X ..:............. , r 'D' Box _____ Type Filter Materia'L�'"r 9.9.t-Depth-Filter-Material -----------/,_'---------------___________ , Distance to nearest: Well _________ Foundation -LU_------_------,_ property Line ___ __________________ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number _.___..____.__ i Rock Filled Yes [3No i❑ 1 • , Water Table Depth -------------------------------------------------Rock Size --------------t==•---------••--- Distance to nearest: Well ---- -------- ------------------R-------Foundation --_------- --------- Prop. Line ---.------------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- r ----°----------------------- Date ----------------•--...-'---•-•----) Septic Tank (Specify Requirements) ----------------------g-------=Y ®�.__ . .•.<-w. ----------;-•----•----- �- __-----------------•--------------------------- Disposal Field (specify Requirement-s) --- '•� �zar __--- �-era-- .cr._--; --�r -------------------•--------------- F t ------- --- ------------------- ----------------------------------------------- --------------------- ----------t--------=----- ' ______________ ___________________ i i ' (Draw existing and required addition on reverse,sicie) 1 hereby certify that 1 have prepared this application and that the work will be tdone 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 such manner as to become s biect to Workm n's C mpensation laws of California." Signed --- fir'" '----01-S -------- .. --. -- Owner r .. . BY --------- ------------------------- ---- Title -------=-------- -- --- --- - - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - Cly-- DATE '��3 }�� --------------------- BUILDING PERMIT ISSUED --------------------- -----------------------------------DATE -- ---- ---- ------------------------------ ------------------------------------------------- ADDITIONAL COMMENTS ------------- -------------------------------------------- --------------------------------------------------------------------------_------------- -- -- -------- -- - - - - -------------- ---- = ---.7/----_ (J--------- . --- - - ---- ---- ----- - ------ ---------- Final ins inspection b ` ------------------------------------------------ Date ............. -----`------- .-e------------ P Y° --------------- ------ ------ --- - ---------------------•*--- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M