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t FOR OFFICE USE: V AIPPLICATION FOR SANITATION K—'41T -------C --------- �, € Permit No.. _1 7 .�L (Complete in Triplicate) This Permit Expires ] Year From Data Issued Date Issued - .y69 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: J08 ADDRESS/LOC TION . ! '� -:--�"_ CENSUS TRACT _... -; --------------------------------------------------• -------Phone _7r� ��7--� Owner's Nam J=am Address ------------------------ ......... •-- w7 --- --- --------- city Contractor's Name 5 7____--&--------------- License # --=3---- Phone ------------------------- Installation ` 6.¢ T--- ----- Installation will serve: Residence [`Apartment House Commercial❑Trailer Court ❑ Motel ❑Other------------------------ ------------- Number of living units:------ --- Number of bedroorps _i&_.Garbage Grinder "*J---- Lot Size ---U--- Water Supply: Public System and name ----------- --------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat❑ Sandy Loam 0 Clay LoamE] A Hardpan ❑ Adobe p 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,} (APACKAGE TREATMENT [ ] SEPTIC TANK[ ] 1 Size------------------------------------------------ Liquid .Depth -------------------------- Capacity f P tY -------------------- TYPe�-------------------- Material.--•------------------ No. Compartments ------------•----�-•-- Distance to nearest: Well '------------------------------------Foundation ----------------------.Prop. Line ----------------- ...... � LEACHING LINE [ ] No. of.Lines ----------------------- Length of each line---------------------------- Total Length :----_-------_----_------- V Box ------------ Type Filter�iMaterial --------------------Depth Filter Material ------------------------------ ---------__-- Distance to nearest: Well ---- -------------------- Foundation ------------------------ Property Line. ---.----_.---.._.,.:.... SEEPAGE PIT [ } Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C1 Water Table Depth - -------------- -------Rock Size -------------------------------- Distance to nearest: Well ----------------------------- -------------------- Prop. Line ..-.----.-.._:....._.. s ,€ REPAIR/AbbITION(Prev. Sanitation Permit # -------'-----,i-----------------.-.-----_---_--------- .Date`I_-_-_.-.._------Y-►-s__�_- --__te----r--✓---- SeAtic Tank (Specify Requirements) f - . Disposal Field (Specify Requirements) ........ _____ _________ ______________)_ ___3__3_ --�---- ------- ---------------- -----•-'----_-•------ ------------------ w-• ..-- ------- --•-•--------•-- -- --------- ---------------------------------------- - ----------------------------------------- ------------------- ----- -------------- - ------- --------------------- ----------------------------------•--- - ------------------------------------------------------ •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 b' ct to Workman's Compensation laws of California." Signed --------- ( 5--- S Owner BY . ------./- --------- ----------- --------------- Title -------------------------- -- (If other than owner) FOR -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY it ----------------------------------------------- DATE - BUILDING PERMIT ISSUED ------------------ i -----------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL --- --- ------•-------------••-•------•--- ADDITIONAL COMMENTS ----------------- ": - - -------------------------------------------------------- ------ - -------- -------- ----------------------------------- - ----------:::::_:::::::::::_------_:: s: '=::: : ::::::___:::_::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::: :9 ::: ;€ ----------------- ------------------------------- --= ------------------------------------------------------------------- -- r Final Inspection b -- �` - - - ---------------------.. Date 1�- P Y �1 � SAN.-JOAQUIN LOCAL HEALTH DISTRICT' li E. H. 9 1-'68 Rev. 5M yi