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g / } " FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - Permit No. ---------- ------------------------------- (Complete in Triplicdte) -------------- --------------------- 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�w hjCounty Ordinance No. 549 and existing Rules and Regulations. du C/ _ _ -CENS ' f} ---- -�-A-�`-A----"r----e---- f �' *w'�' US TRACT -------------------------- JOB ADDRESS/LOCATION ------ ---- . Owner's Name .- n ------ ---------------------- -------------------- -------------------Phone Address y-E !v _(�77 °"r :7City. . --------------------------------------- -;1 i �`F- ��' -----•--------------------------------------- •----- i _ 7f� u 7� a -- License #�2kV Q a----- Phone Contractor's Name __�� 7 ------�-u--r,'-J-7 -- - Installation will serve: Residence[Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- Number -------------------------- ------Number of living units:----- -___ Number of bedrooms _-'2—__wGarbage Grinder L------- Lot Size ------------------------------------- I Water -:---------------------------•- 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'[ 1 Size------------------------------------------------ Liquid Depth ------------------------- f'l�9�k_S7__ Material--- --- ....... No No. Compartments .`L Capacity --- ��-�---'--- Type -- Mtir Distance to nearest: Well ___-__-•50--------------------Foundation -----/-U------------ Prop. Line __�_�--- ..-------- LEACHING LINE [ ] No. of Lines -------'2-------------- Length of each line---- -U----------------- Total Length __/. ----------------- .Sn r/ O-a -------Depth Filter Material _.__/-9_ lC r. 11 'D' Box .-- Type Filter Material -�-- ---�--- ----- ______---.--•-----•---•---•------ Distance to nearest: Well ------------------------ Foundation ------/¢----------- Property Line 5-- - SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ElNo ❑ D Water Table Depth -------------------------- --------------------Rock Size -------------------------------- Distance to nearest: Well --__-______-------•--------------------Foundation -------------------- Prop. Line _-_.__-._----.__------ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------ ----- ------------------ Date ----------------------------------) Septic Tank (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 shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Sign V,/ C-7 scam- Owner By U - --- =--------------- ------ - - -- --------------- Title ----�Q �=`P'F----------------------- ---------- ------------ f other than owner) EPARTM T 115E ONLY APPLICATION ACCEPTED BY ---- - ---= - - ---- -----------'----------- ------------------- DATE ---------------•--- BUILDING PERMIT ISSUED ------ -------------DAT -------- ------------------------------- --- - - - --- ----------- -------------------------------------------------------------- COMMENTS - ---- -- c ------- ------------ --- --- - - - -- f. ------ -----------------------------------------------= --- —�t�-72- ----------Date -------------------------------------------- ----------- Final Inspection by.. -------------------+ ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT C, E. H. 9 1-'68 Rev. 5M