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FqR OFFICE USE: APPLICATION FOR SANITATION PERMIT, -� -� Permit No._Z_4-----7----------------- ------- ------------------------------------------------ (Complete in Triplicate) - 7/ ---- ------------------------------------- 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: ' l � ' A - CENSUS TRACT JOB ADDRESS/LOCATION - - ---- Owner's Name __ ------ - - -------Phone_�i X__-�3� ------ -------------------------------- --: --------- -- i �' Address -- - 1_.��n--- -.(�----� /�.�T��C��--------------------• city ---- _--�-- --�=�-- ------------ -----_----------------- - - W -------------License # ----- --- ------ - - Phone �.�=---�a-=�-��z_�.__._. Contractor's Name ----- ye/1 -r- �T _�_ ,�' --------------- ; Installation will serve: ResidenceApartment House❑ Commercial -❑Trailer Court ;❑ Motel ❑ Other .--------BAR-Al------------------- Number of living units_____________ Number of bedrooms ___________Garbage Grinder ------------ Lot Size _____ 2--k e-&-es-------------- Water Supply: Public System and name ------------------------- ----------------------------------------------- ----------------Private El Character of soil to a depth of 3 feet: Sand V Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ 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 seep ag pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK' Size:' __X_-."f_"- - -----5 Liquid Depth ----U-------- --.----- Q i Ca acit �'OO ____- ___---- Material__ co _ No. Compartments Distance to nearest: Well ___ "�`�" -- � - Foundation -----/0- ------ Prop. Line ../.L LEACHING LINE No. of Lines _________ ____________ Length of each line__-_/0-0-E" Total Length"`..____/6-.G__ -- 'D' Box ------------ Type Filter Material -_____ _ -Depth Filter Material ----------------------------------- ....... I ��6_" __ Foundation .3° Property Line _. __ Distance to nearest: Well _ ------- A-)V----------- SEEPAGE PIT a th -------------------- Diameter ---------------- Number -----------------------=---- Rock Filled Yes,N No i❑ t Water Table Depth -------- ---------------------- Rock Size Distance to nearest: Well __ �-�----------------- ---- - Foun a D---------- Prop. Line _ b- .� --------- Date ---- ----------------------------- REPAlR/ADp1TiON(Prev.PSanitation Permit# _---____._____________________ __ I Septic Tank {Specify Requirements) ----------------- -------------------"------- Disposal Field (Specify Requirements) ----------- ----------" ---------------------------------------------- ---------------------------------- 1 (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 whiih this permit is issued, I shall not employ any person in such manner k as to become subject to Workman's Compensation laws of California." i SignedI --------------------------- Owner " ~ TitleX ----------------------------- By { : (If other than oAer) PARTMENT- E ONLY / APPLICATION ACCEPTED BY ~` -------- ~-- ----- -------- DATE b � � 1 t BUILDING PERMIT ISSUED ------- -- - - --- DATE - -- - ---------- - --- ' ADDITIONAL COMMENTS ------ ---- --- -- ---------------------------------------- ------------- -------- ._. - --------------- -------------- ------------------- ------- ----- ---------------- --------------------------------- - _� � 6 -- --- - - -- ' Final Inspection by: - -------- ----- --------------- .------------Date --- _ '. SAN JOAQUIN LOCAL HEALTH DISTRICT f F- H. 9 1-'68 Rev. 5M