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FOR OFFICE USE: f` _ !p as00 APPLICATION FOR SANITATION PERMIT ---- .� {Complete in Triplicate] Permit No_ ___________— ------------ This Permit Expires 1 Year From Date Issued Date Issued _4Q_-_Z___,681 /t Application is hereby made to the San Joaquin Local Health District fora permit to all the work he described. This application is made in compliance with County Ordinance No. 549 and ex stingnRulestand Regulationsrein i JOB ADDRESS/LOCATIO 77 - - ------CENSUS TRACt Owner's Name ------------ --- - - Phone---- � ---------- --------------------- 37_Q_._ i Address ----- --------------- --------. Ci Contractor's Name ________________ ____ License # ------- Phone - ----- --- ---=- -=--- -- - - - Installation will serve: Residence [Apartment House❑ Commercial:❑Troller Court i(] �Motel ❑Others - Number of living units:_ ---- Number of bedroo s - Garbo rind A/q----- Lot,Size '___._�OQ_ '__/ 5 a ; --------------- Water Supply: Public System and name _______ -" ;_ 1 = ` Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy L rm€0 Clay Loam E]Hardpan ❑ Adobe Fill Material ..___'__.__- If-yesstype-________________I------- (Plot plan, showing size of lot, location of system in relati6n tb wel.l.s, buildings, ,etc. must be placed on reverse side.) NEW INSTALLATION: INo septic tank or seepage pit perm-itt6d.i public`-sewer is available within 200 feet,] f ] SEPTIC'TANK PACKAGE TREATMENT t '[ ] Siz_e____� "-+ � '--•i`---=gliquid Depthl Ca acit ' � ��_��_� � P Y - V, y=•� Type -------------------- Material-------.--------------I No.Compartments �} Distance to Inearey.—Well ------------------------ ~ I 't' =--Foundation -------- Prop. Line --------------- LEACHING LINE [ } No. of Lines ------------ ----------- Length of each line---------........ .... Total Length __-______-- D' Box -.-- --- Type Filter Material --------------------Depth Filtbr Material ----------------- I ; Distance to nearest:-Well------ Foundat-ion•-�--.-,-_-�..-_�___-__- .__ Property Line _ __ ' - --------------•-•--- SEEPAGE PIT [ ] Depth :_r- ---------- Diameter ---------------- Number -------- Rock Filled Yes ❑ No i❑ Water Table Depth --------------- --------------------------------Rock Size _. t Distance to nearest: Well ------- --------------------------------Foundation ---------- -------- Prop. Eine -------•-------------- REPAIR/ADDITION{Prev. Sanitation`Permit# _______.._-__--_------------------_---------- ) Septic Tank {Specify Requirements] ___- i_*,l_t_ � -] 1 --------- -- --- --- r Dis )01 Field (Specify Re uirements) __-- - - } I C ---------------------------------------------- ----------------- -------- -------- --------------------- -------------------------- - -`r -- (Draw existing and required addition on reverse side) I I hereby certify that I have prepared this application; and that the work will be done in actrdance with San Joaquin I County Ordinances, State Laws, and Rules and Regulations of the San`(caquin Local Health District. Home owner or licen- sed agents signature certifies the following: I �+� r-- .—,—,---- I "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 'Col laws of California." Signed ---------- ----- -- y ------ Owner BY ------------------ 7ltle R ------ fir„• other owner] ^-----�---••----- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__--_ i --- - --- ` DATE ------ BUILDING PERMIT ISSUED ----- � ----DATEDITIONAL COMMENTS �. - --------------------------------- ---- - --------------- --------------------------------- ----------- --------------------------- - - Final Inspection b ;e w ----------------- -------------- -------------------- --------- - --- -- ------.Date ----------.-- - ------------- ------ f SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. [[[