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FOR OFFICE USE: � f y � APPLICATION FOR SANITATION .—.MIT (Complete in Triplicate) Permit No. . '��_y ..L --- This Permit Expires 1 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: JOB ADDRESS/LOCATION --- �_9C r' --.�,o. ) /'L2�.r�?!__:5.... C�._......_....... .. ... .CENSUS TRACT - . -.-------------------- Owner's Name ------------ ✓ _�f� 1�� L_ _11. --------------------------------------------------------Phone ��•• Address 7-;:?_9 .E' Cit SToc Tj� y ?._4-�`r-------------- -----------------••-------•--.--- Contractor's Name .. �Ji- -.4_. iq-r'�_2L _F�._-.f S his ��c, _ License # .............. ---- Phone Installation will serve: ResidenceX Apartment House ❑ Commercial ❑Trailer Court ❑ jj Motel ❑ Other - Number of living units:_ FNumber of bedrooms .____Garbage Grinder ------------ Lot Size _4U------ _______ _ -------••• Water Supply: Public System and name .._-------------------------------•-------- -----------------------------------------------------------Private 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 TREATMENT [ ] SEPTIC TANK [ ] Size---__------------------ ------- .. .... Liquid Depth Capacity ----------------- Type ----- ------------_ Material.- -- -. No. Compartments -- c -------- - Distance to nearest: Well _---------------------- ------Foundation ._ . _ _ ------------ Prop. Line ....___._.__._._....._ LEACHING LINE [ 1 No. of Lines ------_---------- Length of each line.__. __- Total Length 'D' Box . ._.___--- Type Filter Material ---------------_--Depth Filter Material ----- ---------- . Distance to nearest: Well ... ------------------. Foundation -- __-------------- Property Line SEEPAGE PIT [ ] Depth __- ------- Diameter ________________ Numbe- _----. Rock Filled Yes ❑ No 4317 Water Table Depth ------•--•--------------------- -------Rock Size -------------------------------- 10 Distance to nearest: Well _-------------_-------_-----------------Foundation --------- ----.__.- Prop. Line ...__...._.._._._._.__16 REPAIR/'ADDITION (Prev. Sanitation Perttx- ____________________________________________ Date Septic Tank (Specify Requirements) LST-/,I-( __ ___________ - --- ------------------------------------------------ D'ispo'sal Field (Specify Requirements) kZ-- - \ K l --------------------- -e:F p-'---- - �, -- --- ------------------•----- ;Draw exi' ing 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 sub' o Workman's Compensation laws of California." d Si ner.ice- , C —� 9 - .1�1�L S -i2-S------ Y (If other than owner) i` c`` — _Titlef�rnKrz --------------------•----------- � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .__- .._. _-______.-•----_ DATE -----------••----------------------•--------- r> BUILDING PERMIT ISSUED -------- ---------•--- •- -------••----------------- ----------------------DATE ........................................... ADDITIONAL COMMENTS -- . -•--------------------•-•-•-••----••......-----------•....... -----•-----•-----•-----••---•--- ----------- --------------•------------------------- .............. - ----------------------------------- ------------............................................................... ..................................... - .. ............ . ----------•---••----•----••------------•--••---•------•----•------------------- �. Final Inspection by: .. --.-- ------------------------------------- -------Date . SAS! JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M