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,tFOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- --------------------------------------------- ------------------------- (Complete in Triplicate) Permit No. Date Issued J_:A�-:(-. ----------- ----------------------------------------------- This Permit Expires 1 Year from Date Issued ' Application is hereby made to the San Joaquin Local Fleaitlf 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/LOCATIO � ZZ = k70 -4 hone ------------------------------------ Owner's Name 0 d - -- ------------------------------ AddressMaty c Contractor's Name --------- =-------- -' - License # Phone Installation will serve: Residennnnnn �;�Apartment House-E] Commercial :❑Trailer Court ❑ Motel ❑ Other -------------------------------------------- ra s [Number of living units:.:-If s_____ Number of bedrooms ---�-----Garbage Grinder __- -- Lot Size _____- __ __________________. Water Supply: Public System fiand name --- ------- ' -------------------- ---------------------------------Private Character of soil to a depth of'3 feet: Sand ❑ Silt❑ Clay' Peat p Sandy Loam •$, Clay Loam; ' Hardpan ❑ �Aj*pT Material ------------ If yes, type ---------------------------- � (Plot plan, showing size of lot, location of system in rel on 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,) I r � / PACKAGE TREATMENT j ] SEPTIC TANK[ ] "" Size I�--X� ---- -- ------ Liquid Depth ------� ------- t ti Capacity/�'rf�"._ �----iType - i - ____ _�_ ______ Material___ ��rt.G�_r_"_ No. Compartments _-_�--______._-__ Distance to nearest: Well ______ - -- --_--------------------Foundation ...lQ------------ Prop. Line --- LEACHING LINE [ j No. of Lines --------- ------- --_____ Lengt of ch... 'ne_____ -_/Of-, Total Length 'D' Box -_--.Z�ype Filter Material __ __ _l ____°___Depth Filter Material _-__ -+Q__ _________________`__....___- Distance to nearest: Well --- ----- -------------- Foundation _______C�__________ Property Line __S_-•______________ SEEPAGE PIT [ ) Depth ------------- Dia `e mber ______'� '-.--____ Rock Filled Yes [ No i❑ -- ==- � �Li� •� iii Water Table Depth_; --------- ------------------------ ------Rock Size 1/ -------- Distance to nearest: Well -----------lC-------.'------------Foundation _______rO_______ Prop. Line _... ----__________ 1 1 REPAIR./ADDITION(Prev. SanitationLPermit# ---'---- --------------------11--------- Date I---------------------------------I Septic Tank (Specify Requirements) ----tIr.--------------- ----- ---------------- -------------------_-..,--------------------------- Disposal Field (Specify ,Requirements) ---------- - -- -------------------------------------------------------------------- ----------- ----- -:..T- »--.. - ---_-_..______-__--- -_ _________________ _ - _ "__________________________-______________-______---__________________-____________-___-_ _________________________._-_ (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 to Workman's Compensation laws of California." Signed ----------------------------- --------------- •-- - Owner B -c-------- "_.�r Title ----------- s 1 tth an owner) f FOR DEPARTMENT USE ONLY Z�01 lop, APPLICATION ACCEPTED BY ------ -------------------------------------------------------- DATE BUILDING PERMIT ISSUED ---------- - -------- -DATE --------------------------= ----------- ' -- -------------- - ---------- ADDITIONAL COMMENTS ----- 2 ----- ---------- ---- - -- ----------------- - -------------------------- ------------------- �------ -.- ---- ---- `A - ------�----------------------- em+-r �,vr_---- �/i,v'--- -- - -- - - ----- --_ --- - --��-. -- ------------ - --_-- --- ------ - --------- -------------------- 1 �` `7�. � ,��.r f- - --- - - -- - Date Y Final Inspection by ----•------------------------- ----- , -- SAN JOAQUIN LOCAL A THwDISTRICT— Q� � E. H. 9 1-'68 Rev. 5M.