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�-,-F-1@R OFFICE USF;, ".�. ' A APPLICATION--FOR !ANITATION PERMIT � 7D- 777 �-- --- y Permi# No. ' w (Comphete in Triplicate) ---- --- -------- - -------- -~--------------- --------- VL Date Issued _lrr "" [ --_----------- -------------------------- --- This Permit Expires ] 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 pplica ion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOBS ADDRESS/LOCATION •J . 3 -------- �� -------------------- ----:------- ------ -- CENSUS TRACT Owner's Name --------- N -------- ' z � Phone ,c n Address ---------r`�`� t°ti ----------- -/ � ✓ ...... ------------------------- City _ C/_ r=, ----------------------------------•---•-- ------.License # -------- ------- ------ Phone ------------------------------ Contractor's Name ----------------- ------------ ------- ------------------- - ., Installation will serve: Residence Apartment House-E] Commercial []Trailer Court ❑ Motel ❑Other ---------- --------------------------------- Number of living units:.._- -_ Number of bedrooms ---e�.,-----Garbage Grinder ... Lot Size ---•--- Water Supply. Public System and name __-____ - PP Y Y ------------------------------------ ----------------------------------------------------------------Private,R Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ ,1► Hardpan ❑ Adobe X 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------- �'__ � X-S_" -___ -- Liquid Depth ___._ -f-----,----= G�► Capacity Ale_"a4�1----- Type - Material____ !° No. Compartments _ --___.:.... Distance to nearest: Well ---- ---------------Foundation ---/o------------ Prop. Line -----�---.------- LEACHING LINE [ ] No. of Lines _______ _ ---_---------- Length of each line------ ----------------Total Length .__-f ------------ 'D'' Box ----/----- Type Filter Material __l]E_PI_ t .Depth Filter Material -----/j---- r f Distance to nearest: Well __-._4171____.___.___ Foundation ---_/C1""-_.-__._-- Property Line _____ ________________ SEEPAGE PIT [ ] Depth __ _ .____-_ Diameter _ _ff___ Number _ "-----2----------------- Rock Filled Yes No i❑ i. - i Water Table Depth __ - ----------------------- --------Rock Size ____� Distance to nearest: Well --- --------------------- ---X42 Prop. Line .___ �__--__ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ---------- Date ----------------------------------} SepticTank (Specify Requirements) ---------------- ------------------`-----------------------------------•-------------------------------------------- ------------ Disposal Field (Specify Requirements) ------------ ------------------------------------ ," -------------------------- ----- ----------------------- ---------------------- = - ------------------------------------------------------- -------------------------------------------- -------------------------------------------------------------------------------- (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 i 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: employ any person in such manner "I certify that in the performance of the work for which this permit is issued, I shall not ti as to become subject to Workman's m ation laws of California." ,r Signed --- Owner --- ---------------------------- BYTitle - -------------------------------------------------------- (If other than owner).,,•. #OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -L.-'--------- - ---- - ------=-----------------------•------------------------------------ DATE _/e_'".,------_�----------------------- BUILDINGPERMIT ISSUED=---------- ----------------- ----------------------- ------------------ -------------------------------DATE -------------------------------------- --- f ADDITIONAL COMMENTS -- -------------------------------------- ------------- �TS__ --- ---------------------------- ------------------------------ - ----- - ----------:-'°' �► -------� ----- - a -n�-44 --------- /_ - y'-a p Final Inspection b ---------------- ------Date --------------------------- ------------------ SAN ----- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M