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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------- ...--S�I---- -- �{ -------- �, Permit No: -��-.74- (Complete in Triplicate) ------------------------------------------------- F This Permit Expires 1 Year From Date Issued Date Issued T, 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 -- �J- G�'------. N�-_ fJ - 7 ... ...........CENSUS TRACT --------------.----------- Owner's Name++ f" � f------�-,------ 9-0,004_7 --------------� � -----------------,--Phone��o =�0/-T� Address ------e `+�1---,_-- r I mo/Irf +----------------------- City, --------- Contractor's Name ---Ifore- e'va-7—e-e-------------------------_--------License #/' 9,Z?,ZPhone -------.-.------- Installation will serve: ResidenceApartment House❑ Commercial ❑Trailer Court ',E] Motel ❑Other ----------------- -------------------------- Number of living units:..../-... Number of bedrooms --�---.Garbage Grinder Q- tot Size974�0_4Z-_------------------- Water Supply: Public System and name'-�4F1i4---- �/�r-_ �---f�________________________________Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay .❑ Peat❑ Sandy Loam ❑ Clay Loam El r i Hardpan ❑ Adobe Fill Material.--_ ----- If yes, type ----:_`__--_.------------ Mot plan, showing size of lot, location of system in relation to weIIs,•buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tankqor seepage pit permitted if public ss ewer is available ,} able within 200 feet `� o PACKAGE TREATMENT [ ] SEPTIC TANK!X Size- -_ _,x-#----xs� _-----_--- Liquid Depth ��--------------- r = ' Capacity --fp . -- Type Material-e-OPA d rz No. Compartments ....... r ♦ �° 1.J t Distance to nearest: Well --------------- -----------------=--Foundation _._,�f>D------_---- Prop. Line -_--__-_--_ Af LEACHING LINE No. of Lines ---- ------------------- ' r /� Length Pof'each line----�'P---------------- LEACHING Total Length .-- - D' Box __- !�/__Q Type Filter Materia'r/�VP44- epth Filter Material ��y _-___.--___._____________ Distance to nearest: Well ----- Foundation .-.1�-.-----.---- Property Line. / �--------------- SEEPAGE PIT Depth -.-- .- -- Diameter -.-?J----- Number __.__ ___ _ - ` ❑ �*r -_ _ -__-_ ___- -- Rock Filled Yes Na Water Table. Depth'_______rpt_-->�r--------------------------Rock Size _ _ --------------------- Distance to neares#:Well _____ _,7777--------------------°----Foundation ...-al-bt�------- Prop. Line -..-.� -------.. REPAIR%ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------__-------------------} SepticTank (Specify Requirements) ---------t------------------------------------------------------------------------ ------------------------ --------------- ----------- } Disposal Field (Specify Requirements) --;--------- -- ------------------------------------------- ------------------7777-�_--i---------------�--7777-- I— ----------------- = ------- -- -------r---------------------------- ----- -------------------- ----------- ----------------------------------------------{--------------7777- -- --- ---------------------------------------------------------------------------------------r Draw existingand 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 SanJoaquin Local Health District. Home owner or licen- sed agents signature certifies the following: ki "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in luch manner as to become subject to Workman's Compensation laws of California." 4 Signed ------- ----------------- --------------------------------------------- Owner 4 4 By ------ -------- --- -------- -'-----=------------------------------------ Title ----l 'dZ '------ -------------- ----------------- 4(If other than owner) # r /FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------. DATE -----J77- 77-- ----------------- ------------------------ BUILDING PERMIT ISSUED r ` �------ DATE ---------------------------------- - ---------- ------ t � LrIt ADDITIONAL COMMENTSQ : - t - -- - -------------------------------7777-- ----- ----------------------------------------------------------------------------------------------- ----- -----------------------7777-- - --- ------------------------------------------ -- - a ----------------------------7777-- --- -- - -- - ---------=--------------------------7777-- - -- - - --------7777-- -------7777-- --------------7777-:------------------7777-- - t r ------------------------7777-- -- - ------------ - - -- - - - - - - - - - -- -- - --- - 7777- -- - ------------------------------------------------------7777-- 77 - -- - --- Final Inspection by: a ' Date --__ SAN JOAQUIN LOCAL HEALTH' DISTRICT E. H. 9 1-'68 Rev. 5M