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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �J�f 1 d--70 /__C�__' ` (Complete in Trip icate Permit No. - - ------------------------------------------------ Date Issued This Permit Expires 1 Year From 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 .��Z--� ------------�i------�}�� - ----•--- ------.-CENSUS TRA ----------- `TRACT -------------- w Owner's Name ._.�1 T ------------- /� � -------- ----------------- ------- -------Phone G� ~Zs �• Address ----- ------------------- City -------------------------------------------------------•------------- Contractor'� Name .At,- -----� /�--------�-�� •------------ --------License # ��?-��Phone �,1 -� � --- Installation will serve: Residence Sl Apartment House❑ Commercial OTrailer Court ❑ Motel F1 Other -------------- ---------------------------— Number of living units:--. Number of bedrooms J-------Garbage Grinder /_ylo--- Lot Size/"----A----l. x.- Water Supply: Public System and name ---------------------- -------------- ---------------------------------------------------------•---------------Private ❑ Character of soil to a depth of 3 feet: .Sand'D Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ j „ Hardpan ❑ Adobe Fill Material ---------_-_ If yes,type A i- ` {Plot plan,-showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.y \ . � NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK1 Size--- ----------- Liquid Depth -- ----------------------- r Material�,&/4! l�^NC o. om artmentsy Capacity!fes- YP r p - A^- Distance to nearest: Vell -----------------------Foundation -----/Q--`-------- Prop. Line ............... LEACHING LINE 6Q No. of Lines ------- ------------ Length of each Iine�, QC.___/ -�-�- jotal Length : --------------- V Box y0'-S-- Type Filter Material JPvGIC-----Depth Filter Material .... _.___----/--------•---- Distance to nearest: Well ____--�-- !>_-_-r___ Foundation --1/1_._-_ _-_ Property Line _S.-_..-..... c �j ♦ r. SEEPAGE PIT [;}� _ Depth _.�LY.�' -- Deter ______ __------ Number -'-- ------------------ RockFilled Yes -V No �❑ �. Water Table Depth ---- ------- --------------=--------Rock Size 1 ----------- � r Distance to nearest: Well .---- -e-------------------- ----Foundation.,_l a_�-------- Prop. Line .: . j REPAIR./ADDITION(Prev. Sanitation Permit# -------- --------------------- --------------- Date ----------------------------------1 G Septic Tank (Specify Requiramenfisl -- ---------------------------- ----------------- - ------------------------•---------- --------------------------------- - •----------- Disposal Field (Specify Requir -------------------- ements} ------------ --------------------------------------------------------- I -------------------------------------------------------- ------------------------ ----------------------------- ---------------------------------------------------------------- ---------------------------------- ------------------------------------ j (Draw existing and required addition on reverse side) a 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 subject to Workman's Compensation laws of California." Signed ---------------- ------/han' ------------------------------- Owner -------- Title --------- ----------------- ---- -------------------------------------- (If otheo nerl r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y --- ------- ----------------------------------------- DATE S -3f Q BUILDING PERMIT ISSUED . ------ --------- DATE -------_-_-- ADDITIONAL COMMENTS __ _. ---1---------------- ------------ -------- ----------- --- ----------- --------------- ... -_- - -----t---i--------- --------------------------------------------------------------------- -.. Final Ins pec#ion by: ---------- ----------------------------------------------------Date 7/-O ..-Q---- V SAN JOAQUIN LOCAL HEALTH DISTRICT h ' E. H. 9 1-'68 Rev. 5M,