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FOR OFFICE USE: .APPLICATION FOR SANITATION PERMIT �1.f�-�=--- --�`-`-¢°------'-------- - ' ,. � Permit No. _..`lob.--lQiF- * (Complete in Triplicate) Date Issued --------------------------_--_-------------------------- This Permit Expires ] Year From Date Issued k Application is hereby.made totheSan Joaquin Local Health District for a permit to ,construct and install the work hereir; described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: � JOB ADDRESS/LOCAT -- wl� ----------- ---------CENSUS TRACT .------------------------- + ---------------------------- ----- -----------Phone ----------------------•------------- Owner s Name --- ------------------(�----�- ,'r 4 - -- ----------------- Citl -fi`------ 1 Address - - Y /" _.._ ---------License #C-%-�.5, __ Phone Contractor's Name _._________ E Installation will serve: Residence partment House❑ Commercial :❑Trailer Court s❑ Motel ❑ Other ----------------------E--------------------- 1, -------------------- ,�} Number of living units:____ _____ __:Garbage Grinder _ I92 Lot Size �� `f ��// �-------------•- g Number '`' drooms --�- / - f -" " Water Supply: Public System and name` __ _ ' ' Private n to ]' s --- Character of soll to a depth of 3 feet:" Sand❑ Silt❑ Gay E] Peat E] Sandy Loam -E] Clay Loam El t f• i Hardpan ❑ AdobeMaterial ---------- If yes,type ------------------------- / 5 /• f ` (Plot plan, showing size of lot, location of�sy`stem in relation towells, buildings, etc. must be placed on rev erseside.j ,i . _'ANEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) � PACKAGE TREATMENT [ 7 SEPTIC TANK f ] Size------------------------------------------- ---- Liquid Depth -------------------------- ,.. p„ it Material __ No. Compartments Type artments a c _ Distance to nearest: Well ----------------- - ,-==Foundation ----------------------- Prop. Line ....................... LEACHING LINE.44] No, of•Lines ------------------------ Length of each line._;----------------'--'-- -- Total Length ______._____•.-------------• �_r✓ Depth Filter Material ____-________-_ 'D' Box ------------ Type Filter Material ---------- p --------- Distance to nearest: Well ------------------------ Foundation --------------- -- ---- Property Line ------------------•-•-•• SEEPAGE PIT Depth Rock Filled Yes No [ l p Diameter Number-.b_== ❑ I Water Table Depth. __ -- ------ -------•-.- ---------- '--Rock Size -------------------------------- : i ;r•— � 1 o i 1 Distance to nearest: W611"___________________ " .Foundation r._----------------- Prop. Line __.___----___-. ------ t � r. REPAIR/ADDITION(Prev. Sanitation,Permit+ ------=----------- Date -------------:1-------------- } p p y q ements) -------- J f ` - Disposal Field (Specifylrequirements) t ------- , ------------------------- = - /f t s --- ------------------ -------- ---- -- --- ---- ---- L-i-------------- -= --� - --------- 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 for 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." " { wner J Signed +� _ -•"--,- ---•-- ---------- ,i t . - ------- ------- -- f - -- ---- --• Title ---- ' Y 7 (If ofihe a -o nbr) �•' 1 F FOR DEP TMENTf USEADKY -- ,DATE _ Fv .t k 4'. . APPLICATION `ACCEPTED B =- -. -- . , ;. BUILDING PERMIT ISSUED �^ -_-- - TE - - �_----------------------------- _ ----------------------- _ DA _t`� =----------- ---- --- / ` t � 7-z� _: i ADDITIONAL COMMENTS _.•._ - -----------------------------------YM. "i --------- ---------- -------- --------- --- - . --------------------- Final Inspection-by -------Date .--- � y� z- QS(QUIN LOCAL HEALTH DISTRICT F H 9 1-'68 Rev. /