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- s, t*-, t FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT I • --------------------- i �` - f (Complete in Triplicate) Permit No. 7_�, 5 a ..........I-----------------------I--------------------- k This Permit Expires i 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 .--- -,--- --_---- I _ _ - 141'---------------------------------CENSUS TRACT -- - ---------------- R --------------- Owner's NameNF - ---------- -Phone ;, - Address --------- S �y - --�-----•----- J } R City I g© 1 Contractor's Name ------40_w—NEK-_- License # --------- Phor'ae'----- ------------------- Installation will serve: Residence A artment Nouse Commercial' Trailer Court Motel ❑ Other----2--------------------------------------- e ' Number of living units------ Number of bedrooms ----._Garbage GrindeXlP� Lot Size ____)TCR 6E-_ .. Water Supply. Public System and name -------------- --------------------------------------------------------------------------------._•._...Private �� r Character,of.soiI to-a depth-of 3.-feet:. Sand' K Silt,❑ �_ Clay .❑ ,Peat❑ Sandy LoamF❑.,CI-ay.Loam ❑ ,.:;� � 4ard0 6 rY❑ 'Adobe-❑ Fill-Material _Md---- If yes,type ---------------------------- (Plot _________________ __ ______(Plot p[an, 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 se page pit,permitted if public sewer is available within 200 feet,) N PACKAGE TREATMENT { ] SEPTIC TANK'[ � +'� Size-------------------------------- Liquid Depth _-___-______________, r Capacity -1------------------ Type-------------------- Material--------------- - No. Compartments l Pro Distance ,to; nearest: _ Well ______________ ____________________Foundati _ n _-_ ________ p. Line LV I LEACHING LINE [ ]` %.No. ofLin"eF - ____------Length-�of-each iline__._.________ __._ ------- Total Length ____________________________ HR 'D' Box�._--------- Typ Filter Material --------- --- ------Depth Fi er 'Material -------------------------------------------- Distance Yo nearest' ell ______________________ Foundation -------- ------________ 'Property Line ____________.___..:___- I SEEPAGE PIT [ 1 Depth -------------------- Diameter ---------------- Number ____________ _____________ Rock Filled Yes ❑ No i❑ f } Writer Table Depth Rack Size . .1 -------------------------------- 7'VJ x Distance to nearest: 11€----------------------------------------Foundat' n --'-----------'------ Prop. Line ------------------ REPAIR/ADDITION(Prev. Sanitation Permit -------------------------- Date ______ ------__________:________) i Septic Tank (Specify Requirements) --------- -------- ------------------------------------------------------------- ---------------------•-----•---- ------ i Disposal Field (Specify. Requirements) .11"?0q------ rw�__15-------- ------M_ov_K------------------ =r ' ' -/4©---------`---6-0.-J...----L C.f-# 1-hf_�--------P---------- -----------�aTl_ v_c.._._ ------- ,S P_rC_C..- "__S ---------------------------------- ----- I {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 ounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents i ature certifies the following: i cerfiify t a in the perform c of the work for which this permit is issued, I shall not employ any person in such manner as to bec s,biect to Wor n's pensati.on laws of California." ' Signed --------- Owner ' --�---- ! BY ----------------- ---f-----'------------------- Title --- - ---------- (If other than owner) I FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------I—A �---------------------------------------------------------- --------- -----• DATE ------ ---_- ,� BUILDING PERMIT ISSUED -------- -. - ------------------------- -----DATE -------------•------------------------••-- ADDITIONAL COMMENTS wa. t. - -A-i--------�-------------'-------f- --------- -- - ------------ - -- - -------------- __ 7 - •----- � J- -- __ — --- -�---n----------_-------_-_- . ----------- ---------- ------------ ' f -- — /�—�n— — -- ------------------`---------' FinalJ __Datet � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M