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w FOR OFFICE USE: - 5 APPLICATION FOR SANITATION PERMIT ' .......... _ 1 (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued Date Issued ..el_ 7t -Lk 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 ...«. . .......CENSUS TRACT .................... Owner's?Name .... /,�.. ` Addressy ._.. -•• ....................... ...........I...--•••---• •_--•---- ......Phone ••---..•-•---.................. f_. � ', .............. City . _ Contractor's Name ..... te"........................................License # � G _ Phone :e Installation will serve. ResidencegApartment House O Commercial ❑Trailer Court 0 I Motel ❑Other ............ - k Number of living : k 9 units ._- .....__ Number of bedrooms _�...._Garba e Grinder ._ ��.-•--•--_-- .� 9 .�f�_.. Lot Size ___•• Water Supply: Public System and name....................... - Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 0 Adobe( 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 tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ) SEPTIC TANK Size..•--..•.._• ----- Liquid Depth Capacity --•--- TYpe ....•-•--••......... Material---------------------- No. Compartments Distance to nearest: Well ---......_ ._. -- . .___..._..Foundation ....................._Prop. line .................. oO LEACHING LINE [ ] No. of- ines L�ngtli of each-line.------•----------- ---- --- Total Length, .............. ... 'D' Box ..........._ Type Filter Material ....Depth Filter Material ............. . Distance to nearest: Well .. Foundation ..................... .. Property Line 9 SEEPAGE PiT [ } Depth =-------=------ ----- Diameter ................ Number --------- . - ------- Rock Filled Yes ❑ No Q Water Table Depth .......,Rock Size Distance to nearest: Well ............. _.-Foundation .................... Prop. Line REPAIR/ADDITION(Prey. Sanitation Permit ............................................ Date Septic Tank (Specify Requirements) .................. __ . t - - Dis osal Field S ecif Requirements) -' -----••-------------------------------••-------....----•---- .. .- . (Draw existing and required addition.an 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 ofvthe-San Joaquin'Local Health District. Home owner or [icon- i sed agents signature certifies the following: -�---- -- "I certify that in the performance of the worg for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's-C mo pen ation laws of California." Signed ... Owner 6 117 By .. ._ - • 0/--------------------- •- ..---- Title //��_ �•� �JP1� ...._._.. other than owner} ----•...........••............. } >:PARTMFNT USE ONLY APPLICATION ACCEPTED BY_.... _ _ /.... .. ._. BUILDING PERMIT ISSUED ..._._ _.,. ... . . •------•............... DATE ZZ/!2—,9:7y ., .......... ADDITIONAL COM ----...--• -•-•••. .........................•.......................... ....... , f - - --- ------------------ _.------_............ ............._..._._ . .-------- f _ ............. -'.._.. Final Inspection by: --------------- - -------------------------- .......... Da JOAQUIN LOCAL HEALTH DISTRICT E. 13 24 1-'68 Re . sm _