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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. __7Q_-- -_ --------------- ---------= This Permit Expires '! Year From Date Issued Date Issued _& .e--_?D 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: ADDRESS/LO ION _ 0 �W.- - �L CENSUS TRACT - -- -- ----- ----------- JOB Owner's Name ------ ---- - ---- ------- �J---------------------------------- ------------------------ --------Phone -=-------------------------- Address ------- _ _ city --- Lr� �. s Contractor's Name ---- - --- .License # �g3 � Phone ! Installation will serve: Residence ®'Apartment House❑ Commercial❑Trailer Court ;❑ Motel.❑ Other -------------------------------------------- Number ------ ------------------------Number of living units:--------- Number of'bedrooms ____V-----Garbage Grinder ----E/---- Lot Size/:7d_,_74--- •�'-d____ Water Supply: Public System and name --------------- --------------------------------------------------- ------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ff� Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-[7] 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.) w NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) U PACKAGE TREATMENT [ ] SEPTIC TANK![ ] Size-----.--------------------------_`_.------------ Liquid Depth ------------___-_____._-. Capacity -------------------- Type ----- ---- - ------- Material--------r---------.-- No. Compartments ------ ------ x Distance to nearest. Well ------------------------------------Foundation ---------------------- Prop. Line --------------------_- LEACHING LINE [ ] No. -of Lines ________________________ Length of each line---------------. Total Length ----------------------- '.D' ___--__--- _-___-_',D' Box -----,------ Type Filter Material ------------=--- ---Depth Filter Material --------------------.---_------.-.--..-.__-- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------.__.-------- SEEPAGE PIT [ 3' Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled /Yes No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- t Distance to nearest: Well -------------------------------------...Foundation -------------------- Prop. Line ..._-_--.-_________-_- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------. _______________ Date ---------------------------- ______----- Septic __-_Se tic Tank (Specify Requirements) - -------------------------------------------- ------- ) - Disposal Field (Specify Requirements) � ryn---,- !( a --------- - S ---- ------------------------------------------------- --------------------- ----------------------------- -------------------------- ------------------ ------------:------------------------------------------------------------------------------- �' (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 Son 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 - - "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 &�,& Q - - Owner Title -" �Cfdti -- ---- -- --------------- ------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -�K�K._ Lam'—----------------------------------------------------------------------------- DATE _/-8 "~2- -------------------------- BUILDING PERMIT kSSUl=1a ----- .r , 41 � - -- ------------------------- DATE ADDITIONAL COMMENTS ----------?------ i . .4 ZO--------�/_--- ------------ ----------- ------------- ------------------------=--------------------------- ------ -------- ------- ------------------------------------------------------------------------------------------------------------ ----- ----------------- �� - -- --- ------- -- ---- ----- ---- - Final Inspection by: ...... U_- ------- - - Date = = SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,