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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT � (Complete inTriplicate) Permit No. ✓/ _---.._.. 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: L JOB ADDRESS/LOCATION 4 J 2VO ;11,01 ` .-lP�/P :r•Te*4�y�---------------------------CENSUS TRACT --..-.------------------- Owner's Name .. r_J�/ 1541A--A,_I~f/hoL `pp------------------ ----------------Phone_5__99:!. ��`_--------- Address ------- ------- ----- -- ------ ------- City - --- - ------ --------------------- Contractor's Name -,License Phone --7y_: � Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court i❑ 6, Motel E]Other -------------------- Number Number of living units:_/--._-- Number of bedrooms .rte --__-Garbage Grinder 11?_ Lot Size ...L_p —el-1;�/PF ---------- Water Supply: Public System and name --------------------- -----------------------------------------------------------------------------.----Private [dam Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Q/ Hardpan ❑ Adobe❑ 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,) /eif PACKAGE TREATMENT [ ] SEPTIC TANK i Size�v,? -- - Liquid Depth .71V-------------------- Capacity --_ Type=:2Wd-_--- MoterialC4&A4V.C7 _ No. Compartments _;_7—-----------__Distance to nearest: Well -: �.----______- p. ___Foundation _lQ-�__-______ Pro Line,/__.�_..._.____ " i LEACHING LINE [LI"' . No. of Lines _�_________ Length of each line_��J--.----.__.__.__ Total Length LSP_,_------......... 'D' BoxY---_ nly- U - -- Type Filter Materiald�-G --_-__Dep4h Filler Material ��_-_____--_------------___..------ Distance to nearest: Well -9.0--------- ---__ Foundation /0-- -------------- Property Line 0�......._.... SEEPAGE PIT [ ] Depth -------------------- Diameter ------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth ----------------------------------------- .....Rock Size------------------------------- Distance -.-----Distance to nearest: Well --------------.-._ ---------------------Foundation ----=--------------- Prop. Line __--_..._____-__-__. i REPAIR/ADDITION(Prey. Sanitation Permit# -------- ---------- Date ---.__--_--..._...._______-__-- 1\` ` Septic Tank (Specify Requirements) Disposal Field (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 Compensation laws of California." •-- - Signed .-- - ----- -------------------------------------------- Owner � By .tr -'-- -- --------- -._----- ----_.--_.- -------------------_. 7itlk3''Lrz''--CTXd/.f��...`.--- ---- --- (If other than ner) _. _..___.EOR APPLICATION ACCEPTED BY - - ---------- DATE --�-� - BUILDING PERMIT ISSUED ---- - ---------- ------ - -- -- f ",_---------`---DATE -` ------------ ADDITIONAL COMMENTS ----------------- ------------ - - - - - -- - Final Inspection by: /� .,y -- Date - F y JOAA1QUIN •LO " H H DISTRICT L E. H. 9 1-'68 Rev. SM Ald-2 �1 r Chi