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FOR OFFICE USE: APPLICATION—FOR SANITATION PERMIT 3 .. ` ,. Permit No: (Complete in Triplicate) ------- -------------------------------------------- 17/1----� date Issued --1-:/1_- - __ ---------_- This Permit Expires 9 Year From 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: 3 JOS ADDRESS/LOCATION . �-•-.J.._�-_/------�=------�1��f.�--�'�1------------------------CENSUS TRACT -------------- ------ �/` Owner's Name __1MR-0-�-/0------CJ'��>f` -------------------------Cit---------- ------- Phone �V/ -11 1------- ,fU Y -----5 °Ct / --------------------------- Address ---------��--�- ----�--- -- �� - -� ----------------- ----- Contractor's Name � a� .�� , -------=-------License # 17 Phone Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court „❑ -r Motel ❑ Other -------------------------------------------- Number of living units:...-L_---- Number of bedrooms __.._Garbage Grinder 'A/V__ ,Lot Size ------------ Water Supply: Pink Ij�S�m and name --------------------------------------------- - - - ----------------------------------------------------_Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay E] Peat E] Sandy Loam ❑ Clay Loam :❑ Hardpan ❑ Adobedj Fill Material ------------ If yes,type ---------------------------- (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 flank or seepage pit permitted if public sewer is available within 200 feet,) i. PACKAGE TREATMENT [ I SEPTIC TANK'V Size__--� �-- - � --------- Liquid Depth ------ ' Capacity TYpe� Material.GNo. Compartments - ---------- tion --- •-- ---- r, ) Distance to nearest: Well -7 �_- -- -------------Foundation ... _ _.---------- Prop. Line .. -_...._..:-------- % LEACHING LINE No. of Lines ----1---------------- Length of each line_ __A00--------------- Total Length' -- --.-------------•- -. Type Filter Material _/P0 ,De-Depth Filter Material -- . _. D' Box _ p ------------ ------ Distance to nearest: Well-" --------------- Foundation -------------------- Property Line_------ ------ SEEPAGE PIT Depth -- --- Diameter -- Number ___.- __.._.�...��---- Rock� I Filled £Yes No i❑ Water Table Depth _011?o---------------- --Rack Size/�-- � Distance to nearest: Well =7�7 ----------F ------Foundation i P•o Line --.J -----•---•-- -- -- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------1--------1 c ------------ Septic Tank (Specify'Requirements) -------------------------- -----------------------------.-------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------ 3 ------------------------------------ ------ ------------------------------ ----- ------ (Draw existing and required addition on reverse.-side) 1 hereby certify that I have prepared this application and that the work will be done nin 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: € "1 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 Compens6t':on laws of California." 4 Signed -------------- ------------------ ------------ -- - - - -------- -------------- Owner ------ Title --------------- - =-------------------- (If other than ner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -./ _ al DATE ` BUILDING PERMIT ISSUED -------------------- DATE ------------ ADDITIONAL COMMENTS -------------------- - ---- ----------------------•----------------- -- ---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- ------------------------ -------------------- -- %�---- - - ------------------------------------- Date _...- l� -------- ------------------------ - Final Inspection by. -tea _ ------ p a i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.