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. .,;FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .__L__/_._ -------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ 1 �t�.--- --.-----�0_��--------5_/71--------------------------- --------CENSUS TRACT --------------•----------- Owner's Name -------- C1/�'T�� .EV � iQ�'� Phone Address 1�'/ �j / U� ------------------•--- Cit v _V ---------------- Contractor's Name ...J1- ____��-,�' J�`_____ - '----------------License #,1 _ __ _ __ Phone Installation will serve: Residence_[gApartment House[] Commercial ❑Trailer Court ',❑ I Motel ❑Other ------------------------------------------- Number of living units:--I------- Number of bedrooms -----Garbage Grincier/yCJ_--- Lot Size /1-2- -0--- © ------------- 1 Water Supply: Public System and name ------------------------------------------- ------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'El Silt❑ Clay ❑ Peat❑ Spndy Loam ❑ Clay Loam :❑ Hardpan ❑ Adobes 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 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK i� Size--_ � ' S--y ---- Liquid Depth .....-r- --------------- Capacity _/,2QD1_Type �i �Mafierial�-c'JNo. Compartments _ ............... Distance to ,nearest: Well ------5-__'-_.- -----------Foundation -f-- ----------- prop. Line S_.�_�..._----•--- 197LEACHING LINE k] No. of Lines-----c2--------------- Length of teach line.__ . .......... Total Length -- -------------- N 'D' Box vol_ Type Filter Material 4e_OC_14�---Depth Filter Material __ ----"------------------------- a � Distance to .nearest: Well ___j rte_____.____-_ Foundation _----/�'.-----.-.-- Property Line _____�.____....___ SEEPAGE PIT De tli __ _jV_---___ Number ------ f7d p �.,�-____-- Diameter �,.---------------- Rock Filled Yes :4 No i❑ � ,, l O e O Water Table Depth ---- -------------------------------Rock Size ------------ DistaDistance nce to nearest: Well ______ �- ------------------Foundation ____lProp. Line -. r.-I-__.---_-_- �r REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date------------------- ._--_--_______-j t SepticTank {Specify Requirements) ------------------------=----------- I------------------------------------`---------------------------------------------------- DisposalField (Specify Requirements) ------------------------------- ------------------------------------------------------------------------------------•--------------- r -- -------------------------------------------------------------------------------- -- ---------------------------------------------------------------------------------- ------------------------ ------------------------------- --------------------------------------------- ------------------- (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, I shall not employ any person in such manner as to become subject t/ orkman's mpens tion laws of California." Signed - - -- -- - --------------------------------- Owner BY - - --- ---- Title --------- --------------- ------------------------------------------------------ other t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ---- �$�- ------- --------------------------------- DATE } ' �'7 BUILDING PERMIT ISSUED J _ DATE f. ADDITIONAL COMMENTS L _ 7J_.. Z , - -- ----------------------------- -------------------------------------------------------------- ------------------------------- E --------------------- ----------- -----=---------- ----------------- ---- ------ ------ ----- ----- ----------- - _ } Final Inspection by: -- ---------- Date 3 /--- E SAN JOAQUIN L AL HEALTH DISTRICT ) E. H. 9 1-'68 Rev. 5M,