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FOR OFFIFE USE:• y APPLICATION FOR SANITATION PERMIT ;. - Permit No. ----- ---------------------------------- --------------"I —._ (Complete in Triplicate) - Date Issued ---__.__:�Z •� This Permit Expires 1 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„compliancl with County Ordinance No. 549 and existing Rules and Regulations: 1 -� �.--------CENSUS TRACT ---4.{----- --- ------- JOB ADDRESS/LOCATION .-----1T.6.-0 ----S------- _ ,--------- - x -------13os'.�__G1_C E1K-0-- ---------- `= ------------------------- ------------------- ----------------------------- Owner's Name .-- _- - � ,- d 0- ---------15-------- _!. !__ -----------------------. city Address _-___----�-J-6 - � � _f�AX_D� ---CQ►�1cYT P1 P __ ---License# ----------- ------------ Phone -------------------- --------- Contractor's Name Installation will serve: Residence artment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other -------------------------------------------- -” S --------------------- �Jrr "—F--- S Number of living units:_____ .� __-_ Number of bedrooms _ -----Garbage Grinder Lot Size -- -----� �______ Water Supply: Public System and name --------•-------------";-------------- = - - Private Character of soil to a depth of Veet: Sand'❑-, Sil - Clay ❑ .Peat❑ Sandy Loam ❑� Clay Loam Hardpan , 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 seepa pit ermitteriap ifblit sewer is available within 200 feet,) /( X / = Liquid "Depth --- PACKAGE TREATMENT { ] SEPTIC TANK;FN. Size ___ _ - - ------- Capacity �W_ --e•- Type g�AerialC CRT'- {�^C�artments D -s- ------ --Foundation _.1--[/ Prop. Line __ "•` istance to nearest: Well ___ � LEACHING LINE No. of Lines _ �, __ Length of each line-----7� --------=- Total*Lengthlr_rte I---•• M1 i 'D' Box -�Type Filter Material n ---Depth Filter Material -___ �, _ __ �1 a �`----- Foundation -- Property "Liner --'5----•---------- Distance to nearest: Well` �------,-- � �� Rock Filled Yes �7' No �❑ SEEPAGE PIT [ Depth __/,��----------- Diameter/ X -- Number ----------- -------- r ;r , Water Table Depth _____� ---------------------------------------- Rock Size --- Distance to nearest: Well.'____-1Q ------------- -----Foundation ---.1�---------- Prop. Line --- -----.•------ �. 5 REPAIR/ADDITION[Prev. Sanitation Permit# ....." '------------------------------------ Date ---------------------------------- --------------------- Septic ----- ---------------- - -- --------------------- Se tic Tank (Specify Re uirements) _________________________---------- ---------- --- ---------------------------------------- - — Disposal Field {Specify Requirements) `_--= -`T=-•------------------- - -------------------------------------------------- --.-------- ----- -- --------------------------------------- - 4 A e ______ — -.i• L J - - _ _ _______ I_:----------- _ ____________ !-.______-_--__________---________-------------------------------------------- ( (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, 1 shall not employ any person in such manner as to 3ba asubject to Work n's Compensa 'on laws of California.g � = nSi ne - - ----- - -- -------- ----- --- Title ------- ----------- ---------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY :_- a -�Q ` DATic 2- - 71-------- -- ---- ----------------------------- - -- BUILDING PERMIT ISSUED ----- --- ------ ----------- ---------- ----------- ---------- - ------------------------------------DATE ------------------------------------------- ------- -------'k ADDITIONAL COMMENT = - = - _ = = -------------------- ------ - = ----------- -------- --- --------------------------------- ------------------------------ ----- ---------------- - ---- _ - -- . -- ---------------------- ------- -- - ------- ........... ------ -------- --- - . -- ._ --- -- Date - --------------- ---- - - - - = -- - -- Final lnsp SAN JOAQUIN LOCAL HEALTH DISTRICT E, H. 9 1-'68 Rev. 5M