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l FOR OFFICE USE: 3v APPLICATION FOR SANITATION PERMIT -7 Permit No. (Complete in Triplicate) i -------------------------------------------------------- I Date Issued F-�fE?v ___________________________________--__-._--___--_ This Permit Expires 1 Year From Date Issued 0 l�( yy wuct Application ;s hereby made to the n Joaqun Local H!t D t ctfor� elmit o co© nd instal! the work herein ! described, This application is made i o ,�rtye withFounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .I1/5- ---- ---- - -- --------- 2 --- __CENSUS`TRACT ____ P Owner's Name Phone I Address �� 3 � __.... City �y License # c�_ '6- 7-7-- -- Phone Contractor's Name � .-- - d _�hs___!�(---- --- --- -- - - - - - 1� 3 12,Installationwill serve: Residence &'Apartment House❑ ommercial :❑Trailer Court i❑ Motel ❑Other ----------------------------------------- Number ----------------------------- ---------Number of living units:-----[------ Number of bedrooms- �'-Garbage Grinder Lot Size .* ---------------------- -----------'----fix=- =---- `-------i--------Private Water Supply; Public System and name ______ _______ ______________________ _ JAI Character of soil to a depth of 3 feet:N San'❑ Sift❑ Gay ❑ Peat ElSandy Loam ! Clay Loom .E] I i Hardpan ❑ 'Adobe-❑`' Fill Material ------------ If yes, type (Plot plan, showing size of lot, locatioii system in rel dtion to wells, buildings, etc. must be placed on reverse side.) O NEW INSTALLATION: (No septic tank•or seepage pit permitted if public sewer is available within 200 feet,) (� PACKAGE TREATMENT ( ] SEPTIC TANK'[Dp " i.Size------- -------------- ------------ Liquid Depth ___G __ — Capacity _ 1! o_U_G,f T 11ype )E--- Material_G- -----'M� 7—__ No. Compartments __` ______.:.._. Distance to nearest: Well ------- j2_ _____________Foundation Prop. Line ---------- ..:..___--_ :- LEACHING LINE [ No. of Lines _____3-------------!_ Length of each line/04-`�-250j,41- Total Length .map_.'. D' Box U _____ Type F;Iter Material Depth Filter Material _ `� * s-__7�a____P________________ pistance to nearest: Well Foundation s� r CX Property Lir1e ---`---------------------- � i 3 SEEPAGE PIT [ ) Depth #--- --- Diameter //__- &_. Number __ Rock Filled Yes g No .0 Water Table Depth ------------------------------------------------Rock Size ---------- f ��,-}- Distance to nearest: Well __75_}_If_20 ------------------Foundation:,3a =__--_____ Prop. Line _Jr_�___.-._ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________I Septic Tank (Specify Requirements) ------------------- -------------------------------------------------•-------------------------------------------------------- Disposal Field (Specify Requirements) ----------------------------------------------------------------------------------------------------------------- ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.------------------------ --------------------------------------------- ---------------------------------- --------------------------------------------------------------------------------- -------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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." Signed ------------------ - ------ ---------------------��-•---/------------------------------ Owner BY l.L✓CC J ------ Title ------- ------ 4l ----- ------ --- ------------ (If other than o ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---- -- / - ------------------------------------------------. DATE ell 0/2 b -------- ----------- BUILDING PERMIT ISSUED -------------------------------------------------- -------DATE ------------------------------------------- ADDITIONALCOMMENTS ---------------- ------------------------------------------------•-------------------------------------------------------------------------------------------- ------------------------------------------------ ------ ----------- ------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------- Final Inspection b ------------------Date ----- '`=-1XV-'j/- --__-_-- - _-- p Y- -------- - ------- - -moi - ------------------------------------ ----- SAN OAQUIN LOCAL HEALTH DISTRICT U� E. H. 9 1-'68 R . 5M