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FOR OFFICE USE: r _' --? �'" 5 A?P.LI.CAPOW' l SANITATION PERMIT ` (Complete in Triplicate) Permit No: ------------------------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued _ �A Application is hereby made.to the San Joaquin Local Health District for a permit to construct and install the work described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._-°-l_'7"- ----- /cr�s_ ------4�/R------ '-gip f- CENSUS TRACT ----, -7-- ----_- Owner's Name 1t - _ I-`-- ------------------------------- - I -- �-`�� --------- �-------PhoneAddress -----/ � Gt.�i✓2-----h-ze-e --- ----------------------------------------------- Cit Y ----------------------------------- -------•---- Contractor's Name•__.�1--_;," --------------------------------------------------------------- -------License # -7=------------- Phone ------ Installation will serve: Residence KApartment House❑ Commercial:❑Trailer Court ;❑ Motel ❑Other ------------------------------------------•- Number of living units:___!- Number of bedrooms _3-------Garbage Grinder --- Lot Size Water Supply- Public System pp Y y and name ---------------------- ---- -------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt[j Cloy & Peat❑ Sandy Loam ❑ Clay Loam ❑ 3 Hardpan ❑ Adobe'E] 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 seepage pit permitted if public sewer is available within 200 feet,)' PACKAGE TREATMENT [ ] SEPTIC TANK Size- __-!CX .9----------------- Liquid Depth ------------;_1------------ \Q-1-- -- Capacity /tea e ,�� ca5 " Material o. Compartments ___ —____.._._.- Distance to nearest: Well ----------------------- r -- --- -- Foundation �_-�---------- -- Prop. Line e_,0---= LEACHING LINE [ ] No. of Lines _______----------------- Length of each line______ -- Z g `lro4C�------ - --- Total Length - C3 F 'D' Box �_ Type Filter Material __._ _____ _Depth Filter Material - - Distance to nearest: Well -__ _____________ Foundation 1-6 ------------ Property Line l SEEPAGE PIT 77 'Diameter _______________ NumberWater, -_______-___"-___.___ Rock Filled Yes ❑ No C]Depth Table Depth -------------------------------Rock Size .t Distance ------------------ ce to nearest: Well -------------------•--------------------Foundation __ Prop. Line ---------------------- REPAIR/ADDITION Sanitation I (Prev.( &tion Permit# -------- ----------------------------------- Date ------------ -------- ) Septic Tank (Specify Requirements) _____________________"__ Disposal Field (Specify Requirements) .____-______ ------------- ------------ 1, ------------------------- --------------------------------------------------------- (Draw existing and required addition on reverse side) I he y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents-s is nature 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 Workman's Co ,nsation laws of California." Signed7 " �� Owner BY (If other than ow--n-e r)------------------------------------------------ ---- T -itle ..-----------------------------'---- --- FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .__` DATE - d ----------- -- --- -r ........... I DING PERMIT ISSUED __ _ _ ------- - ----- - ---------- --------------DATE ------- ---•----- ADDf710NAL MMENTS _ _ _ -"-"�--"---�"--- --------- -----' 7 ------- 1 / -------- =--- -- / 1 3 ` - - - - ----------------- - --------------------- Final Inspection by: -- _ 4 ;----/f --------------- f - -- ------------ --Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT E:H. 9 1-'68 Rev. 5M G� J