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`/ FOR OFFICE USE: r APPLICATION FOR SANITATION P"IT 4- 7 -- `s7 ?�,riJ � Permit No. - -- - --- ' (Complete in Triplicate) This Permit Expires 1 Year From Date Date Issued _ ..............................__ _ . .__...---._---. - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereir described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �� ---.-��-'----------------------------------CENSUS TRACT _ Owner's Name f 41 �.. V c............................I----... Phone fz .-. /..? 1------. Address -------------------- -----/-- --�-v- ----' ---------------- City --c,l�'�-�- �-...-..---------/- ----_---------------•-- Contractor's Name - Y c �sTcGiJ.. ---------.License # --- Phone Installation will serve: Residence Q!Wartment House-[] Commercial []Trailer Court C] Motel ❑ Other------ -------------------------------- Number of living units:_---l.... Number of bedrooms --.7gg.....Garbage Grinder ------------ Lot Size .... ............ Water Supply: Public System and name --------------------------.........._-..---------------------------------------------------------------....PrivateX Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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,)PACKAGE PACKAGE TREATMENT [ ] SEPTIC TANK S'ze.-----�-_x1A1�------------------------ Liquid Depth .................. Capacity Type .> ...... ....... Material.. .-__. No. Compartments ...... .............. r r� Distance to nearest: Well ...--�Q--.:r -------_...Foundation -..� r0.......- ... Prop. line _. ................. LEACHING LINE I No. of Lines --J- -7i�-....-... Length off e`ac�h line._- ----___ ..-- Total Length -.�.7�............... 'D' Box ...-` _ Type Filler Material ; .....--Depth Filter Material -----,.p r� - Distance to nearest: Well ---5'0'-t ---_-. Foundation _!-L' '..t-. Property Line ___ir............... SEEPAGE PIT � Depth .. ...... Diameter ...... Number -.-.---71.--_. ------ Rock LFilled Yes No Water Table Depth ........................ --Rock Size Distance to nearest: Well ----1..0.0.....:---_-----------Foundation ....10..-t'... Prop. Line ....$'_ .-....._. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..........---------.--------------I SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------.........--------.......... Disposal Field (Specify Requirements) .-............................... ...------------------------------------------------.-_---------------_ ----............---.- ------- -- ------... ........ ... --------..... .... ........ . ............ (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 'o become subject to Workman's Compensation laws of California." Signed _..... /. -[.- . . .----- .. . -a ^. --- -" Owner By _ ---` 1i c- s - ..... .._ Title CiSLA ----- --...._-._... .......... (If other n owner) EPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... -----------. DATE I. 7 Y.-.-_._------- BUILDING PERMIT ISSUED . .... . --- --- --- -- -- ------- ....- - -....--DATE ..._ - ...__........... -----ADDITIONAL COMMENTS . .. . .-.- 'f-- ------'--.---.. --------....-._..-. _.._-.... .._._-------------- - ----- ---- -- ----'--'--------'------' ------ --'------- Final Inspection by: ... -.._ .. .....----- -------...--------- ------- - -�/ / ..--.........----- JOAQUIN LOCAL HEALTH DISTRICT v E. H. 9 1-'68 RSM