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jFFICE USE: APPLICATION FOR SANITATION PERMIT 7 Z -6 1 . Permit No- --------------.-- S .4 (Complete in Triplicate) ,� ----"- "-- date Issued _ This permit Expires 1 Year From Date Issue - lcation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein Appi nce with County Ordinance described. This application is made in compliaNo. 549 and exis?ing.Ru!A ndRegulations: w JOB ADDRESS/LOCATION .__ AS If � � r:; ENSUS"TRA -----------------•-------- - ---------- Phone Owner's Name y,�dr'• 'a----��`� �� = City -e5'�� --------------------------------------------- ------ ------ ------ -------- -- Address '070 .0v7 - ----------------------••__. License # '�� Phone ' """ "" - ---------------- ---- Contractor's Name Installation will serve: Residence)(Apartment House'❑ Commercial ❑Trailer Court lI] Motel ❑Other -------------------------------------------- i s � �- f ' Number of living units:.__________ Number of bedrooms - ----_Garboe GrinderLot Size -- 6' C��9� _private E]Water Supply: Public System and name _ - ' -------------------- - - ` Character of soil to a depth of 3 feet: Sand❑ Silt I-] Clay ❑ Peat F-1SandyLoam ❑ Clay Loam :❑ •. y e ---------------------------- (Plot --------------------------- Hardpan ❑ Adobe � Fill Material _____.____"_ I es, typ , Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I ; NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet_,) � � Liquid Depth � --------------._--- PACKAGE TREATMENT [ ] SEPTIC TANK Size- _ Capacity �'Q---- Type t `4440-- Material E��"--"----- No. Compartments __--------` -------------------------Foundation _-��_ _ Prop. Line ---` --.:.-----•- Distance to nearest: We --"~""� -- ------- - ______________ Length of each line-- -f---------- -- Total Length 1,7_4?_------------- - LEACHING LINE No. of Lines -- -- Depth Filter Mafieria! h A D'.Box�tco ._-Type Filter Material "y- � _ Foundation ----*�----------- Property Line Distant nearest: Well --"^ "" �� Rock Filled Yes No .0 Depth Diameter � ------ Number -----�-- SEEPAGE PIT [�' p -"02-1 ---- �, U —�� ✓ l Rock Size ------- Water Table Depth _. ---- ---- j ! �_------ Prop. Line _-o�.--- Distance to nearest: Well ____- - ----- Foundation e► Date ------------------------• ) REPAIR/ADDITION(Prev. Sanitation Permit _ - =- �. , Im _ _ -------- ---------------------------- Septic Tank (Specify Requirements) ------- ------------- --------------------------------------- ------------------------- - ------------------------------------ Qisposal Field (Specify Requirements) --------------- ------------------------------- - y ------•----- ------- ------------------ --------------------------------------------------------------------------------- 1 ----- L_-------- ------ ----------------=-------------------------- -- ----------------------------- (Draw exis#ing and required addition on reverse si e I hereby certify ; 1 .have.prepared„ this,.appl cation.,,and.that-the,work�will.,,be�done�in:,,acc_or thatdance with San Joaquin County Ordinances,jState Laws, and Rules and Regulati o's of the. San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: W Ii "I certify thai in.the performance�of-the-work for-which-this-permitsis�issued tlrshali not employ any person in such manner as to become subj ct to Workman's Compensation laws of California." Owner Signed ----------------- :- --- ------------------------ T,itl.e .. c By (If of -than owner) FOR DEPARTMENT USE ONLY ------- ------ APPLICATION .ACCEPTED .��-� ------- ------=-- -=---�--- . DATE- --- BY _C----- - DATEa1C BUILDING PERMIT ISSUED -------------------- --- ------------ --------- ADDlTlONAL COMMENTS ----------------------------------------------------- '"` ----------------------------------- tv __ _ ----------------------------------- -------------------- --------------------------------------------------------------------------------------------------------------- ' � -------- --- ---------------------------------------------------------------------------- --------------------.------------ ----------------- - - ! ------------ ---- ----------------------------------------------- �.' /JOACQUIN -------------- t Final Inspection b LOCA L HEALTH DISTRICT ' vN E. H. 9 1-'68 Rev. 5M.