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FOR OFFlCE'USE: APPLICATIONOR SANITATION PERMIT ---------------------- -------------------------------- '��-__ �_(7 (Complete in Triplicate) Permit No. . --------=-------------------------------- -------------- _________________ This Permit Expires 1.Year From Date Issued Date Issued ...�.-1_-___7/ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: d. JOB ADDRESS/LOCATION --- _ _ _-_.s� _______ _ !,_CENSUS TRACT __.__.__._':� 7____ Owner's Name _21� — -- --- / �' a... ------` -g�� -- ;k ' .:__Phone Address �� Q = HAL�---------f--T-------------•--. City --. -� L r ------------------------------------- Contractor's Name -------- --W_ _Ai-F -------------- --------------------------------------License # ;':" "--- --- Phone ------------------------------ Installation will serve: ResidencOK(Apartment House❑ Commercial ❑Trailer_Court '[3 w. Motel ❑ Other -------------------------------------------- 4! �r Number of living units------ Number of bedrooms _?,.--- =_Garbage Grinder ---_o_ . Lot Size ..Ct4_ - — ---------- Water Supply: Public System and name ------------------------- --------------------------------------- ------- •-- •--------.Private. Character of sail tooSClay -Peat—ff m ❑ Cay Loi � am. Hardpan ❑. Adobe Material fes, type ---------------------------- 1 (Plot plan, showing size of lot, location of system in.ie'lation to wells, buildings, 'etc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank or seepage pitpermiftecl-if public sewer�is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK ] Size--------------------- ----------- ___ Liquid Depth _____________________-_-- Capacity ---------------- --- Type --------------------- Material:_:'1Y_i-..--- Compartments ----------_----------- CJQ , 4 ----- o. Com Distance to i neares : Well ------------------------------------FatAdation --------------------- Prop. Line ---------------------- s'' - -------------- Total Len th ------------- LEACHING LINE [�] No. of Lines _________ ------- of of each line__ g ___._.______._ 'D' Box ------------ Ty. `e'fFilter Material -------------------DepthFilter ateriai ---------------------------------------___-- ,Distance-t.arest: Well --------------—1-_--_--Foundation .�_ -_. ________ Property Line } " p Number ..____. '_ ---- ___.._ Rock Filled Yes ❑ No ,0 SEEPAGE PIT' uepth • ____-_.°_-__________ Diameter ___##____'_ Water Table Depth --------------------------- ------------------,Ro&..Size ---- ------------------------- Distance to nearest. Il ---------_____?___)±-------------------Foundation _ _ -------------- Prop. Line _____-____--__-_-___-_ REPAIR/ADDITION{Preva Sanitation'Permit J_ -Date,,-------j------ ------------------ -- ) Septic Tank (Specify Requirements) ----- ----- Disposal Field (Specify Requirements) _ -- -------------- - , -----44o* --F I {Draw existing and`required addition on reverse side) 777A a I hereby certify that.,1l have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, fate Laws, and Rules and Regulations of the San-Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certif in th perf rmance of the work for which this permit is issued, I shall not employ any person in such manner as to bec svbi t to o kr�nan's Compensation laws of California." Signed ------- -.., ..------------------------------------------------ Owner i ----- ------------ �. BY -- -----------------=---��=--------------- --1-- - =- ----------- - Title ------------------ ---------------- -------------------------- -------- {If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ � ------------------------------------- DATE --- �- ---------- BUILDING-PERMIT ISSUED--:_:_-__---�t-=- ---------------------------------- - —�- ___—DATE �_ --------- ADDITIONAL COMMENTS - --- - - - --- - ------------------------- r �5_ -------------------- = Final Inspec i - ---- ---------------- -------------- --- --Date --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'48 Rev. 5M _- -