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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ _.... - Permit No. ---�� ?0 5 (Complete in Triplicate) Date Issued J�e _ .-..____...--_.......... . ------.._....._..... This Permit Expires 1 Year From Date Issued .'.-.p 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 Co ty Ordinayn�ce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _/_ v_ __-_ !__ u L/.............._-----.-._._..._CENSUS TRACT ---.................._... Owner's Name --...... -�1-.-- - - ------ ---------Phone ----................................ Address ----------- �� .�"'J: �' -------------------------------- -------------- ---- ....... City _T/�e4�. --------- Contractor's Name ._l�C moi.=/E✓ 1------- ------------- - --------------License Phone ............................. Installation will serve: Residence ❑Apartment House❑ Commercial 'frailer Court [] Motel ❑Other --- --------- ...... ��tt�� 1 �.�-` Number of living units:.--/----- Number of bedrooms..-_.Garbage Grinder i�r-_ lot Size /_ lLc.r................ Water Supply: Public System and name ------------------------------•----------------------------------------------------------------------Private)' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loom Hardpan ❑ Adobe❑ Fill Material ------- If yes,type ......---__________________ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) IiN NEW INSTALLATION: (No septic tank or seepage pit permitted if Ipblic sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK�d Size_, /X.,.?,JCsf_._-------- --------- Liquid Depth ___ Capacity/- eQ--„__ Type �ezF _ Material L`yf�j a.. No. Compartments ._.Z--:_------_ \ Distance to nearest: Well _______ _ ------------------------Foundation ------------- Prop. line - ...;..._-.-_ LEACHING LINE No. of Lines �________ _____ Length of each line.--694— . _..._ Total Length l 'D' Box -.VX$. Type Filter Material 1�.ZXZDepth Filter Material ��:___.__...-_--_----------- � Distance/to nearest: Well ..s " -__---____ Foundation a te-------------_ Property Line ........ SEEPAGE PIT [ ] Depth .-/tom!-_.__ Diameter Number ----0�f7---------------- Rock Filled Yes,[ No 0 Water Table Depth --. `-...................-•-------Rock Size ��- `------------ !X Distance to nearest: Well ---,eCtIll—P-...................Foundation .___ Prop. Line -_ .._......... REPAIR/ADDITION(Prev. Sanitation Permit# -----------___.__.._.----------..___....... Date ------------------............. ._.) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------- ---•^ DisposalField (Specify Requirements) -------------------------------------------- __________ _________________------------------------------`.... --------------------'-----------------------------------------------------.........-----------'----------'---------------- ----------------------------- ----- r (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 Compensat--ion laws of California.” Signed ------- - Owner By ------------- - -- Title ------�,yl/Z�----> --- -------- owner) FOR DEPARTMEN !!g O LY APPLICATION ACCEPTED BY ---------------- -------------------- - - --------. DATE ./.:- 7� ------------- � BUILDING PERMIT ISSUED _.-....._. DATE ..______....._-_-_-...._-_-..-------- ADDITIONALCOMMENTS --- -------------------------------------------- - -----_-------- ---------------------------------- ------- --------,--------------- - -- --------- ------------------------------- --------------------------- _..-.. - -... &CT-_------------- .....- -- -- ------- - -------------------------- -------------------- --------------------- - --q y Final Inspection by: - -- -...` - ------ ---- - -------- - - .Date --.L.-j f �� - SAN JOAQUIN LOCAL HEALTH DI E. H. 9 1-'68 Rev. 5M