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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �, (6.--- " 13 fCompfete in Triplicate) Permit N . ., -_- -„----•, o - 71 -!l .......-................................... This Permit Expires f 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: 94G 6 , JOB ADDRESS/LOCATION ----- .. .__ ! !e �.-, --. �pENSUS TRACT _-. Owner's N HCl-'� `--- s i-'-/!1..--------•... ------- ------..Phone .----------------------- F— -----....... .---- '-'- i I Address - '. ., a� -- - - ...-.-.-..City -,Z1Svf ..-....t� r p Contractor's Name-. .-c]',7 .- -----'---------------- ---- ........----------License#17-7.;$-Si3 Phone -4`_........2 7.G ------------- Installation will serve: Residence Apartment House C] Commercial)]Trailer Court 0 Motel C]Other..------.............. - , Number of living units:---1.-.--. Number of bedrooms _ -......Garbage Grinder ..... Lot Size : ...........:. -- Water Supply: Public System and name ..........................................--w ,-•-----,Private)z}•' Character of soil to a depth of 3 feed-,__Sarrd�_Silt Clay_j$ Peat p Sandy Loam Q ' Clay Loom C] Hardpan ❑ Adobe o 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,`ank or seepage pit permitted if public sewer is available within 200 feet,) ..� PACKAGE TREATMENT [`r aEP11 TIC TANK t ] Size..--Sp..�.?�,..y9.xS--r.---, Liquid Depth ---�.-'-------------- ' Capacity Type RsrrMaterial.,>(.177t:+ No- Compartments ........... Distance to nearest: Well -.....?v-..-"................=: .Foundation:7D- ....-..-.. Prop. line .s..r....-......- 4 LEACHING LINEi [r]'� No. of Lines -..Z................ Length ch line- ..... Total length ................r 'D' Box -. - Type Filter Material ----------Depth Filter Material _-.--._. „-......,..- Distance to'nearest: Well .r00---�---• -.- Foundation �.I�--:;"............. Property Line. 3..._-............... +� SEEPAGE PIT [a-- Depth ...%t.� �,-„-_ Diameter .-.--r - Number ... .� ` f, -- Rock Filled Yes � No Water Table Depth . - -......-------------Rock Size ....a--r:-....-'-........... f� Distance to Nearest: Well ...-.--.__.-•------,-r..,....,.........Foundation ................... Prop. Line ..................... REPAIVADDITION(Prev. Sanitation Permit# ...............-...^tz -•,-„ .,----...,,_ Date ...................i, k. Septic k Se tic Tank (Specify Requirements ) -- ---'----•--- --_-..---._----------------------......-- ------—---------------- Disposal Field (Specify Requirements) ...........n.: c ............................................ --- ----•- .......---'-•-----............................... (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, an'd Rules and Regulations of the San Joaquin Local Health District. Home owner at 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 ........ . ..... - ....- .-.-... f Owner By -------------•• >s ...-.-.: - -._ - - ' Title ................. ................{I other than owner) ! , FOR DEPARTMENT USE ONLY �y I APPLICATION ACCEPTED BY.--.., -r°-- --,.. -- .11..L'tQ:_an.../--� ................._. DATE ---- --r.._St7.... .....- BUILDING PERMIT ISSUED.............:! DATE .. -.......- ADDITIONAL COMMENTS ...- � J - - .....--'-- -- .. - -.....: .......................... �-�...,---. - ----------- ----------------------------------------------------------------- ------ ' - ------_---------------- -------------- // .-' - inal Inspection by: :.. `-e �e--,.t. ' u - � � -' -...........................------_-------------Date .-. SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M f