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�J FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r --- Permit Nd. _.71- ---- / r (Complete in Triplicate) 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 r described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. f ` ---------- CENSUS TRACT Owner's Name --------- - - ---- -------� -----•----•--------------- ------ ------- Phone - _....... Address - f 7//, city Contractor's Name.--------_---- ------- ---- ---_-- -_t:- - f3!t/� _-----.License # t&O-SW Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court.;❑ - t 5 " I I :1Q_1' .Motel ❑ Other --------------------------------_------•--- Water Number Suof living units:- Number of bedrooms -_ ____Garbage Grinder _.._ _ _-._ of Size 9 � ,o s Supply. `f is System and Hama Private ❑ ----------------------- ------•-- Character of soil to a depth of 3 feet: Sanyd-'❑ Silt 0--?flay L❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ }lHardpan ❑ Adobe 'Fill Mia#erial -------- -- If yes, type -----------=-------- (Plot plan, showing size of lot/location-of=system-in-relation-to,wells,•bui Idings, etc. must be placed on reverse side.) NEW INSTALLATION:.�' � } (No,'septic tank or seepage pit permitted if public sewer is available within 200 feet,) Ir PACKAGE TREATMENT { SEPTIC TANK'[ Size-----------------------------------k----------.- Liquid Depth --------------__ Capacity --- --------`----•-- Type -------------------- Material-----------------t--- No. Compartments ---------------------- v Distance to nearest: Well �'� �, - Foundation LEACHING LINT; ; No. of"Lines ----- ------------------ Len�th-of-e --•------- -------------------- Prop. Line .-----------.:....__-- � 9 each line----------- - ` ---- Total Length ------------- -------------- ` �; 'D' Box ------------ Type Filter Material __-________________Depth 'Filter Material -___._____. -_--_ --- } Distance to nearest:-Well -------------------------- Foundation ----------- ------------ .Property Line --------- SEEPAGE PIT [ Depth ---------- Diameter _______________ Number ------------------- ------ Rock Filled Yes ❑ No ❑ R ' Water Table Depth ---------------------_..____ ---•----Rock SizeJ-------------------?----•=-- Distance to-'nearest: Well ----------------------------- ------Foundation ----- - --- ,_- ' Prop. Line ----------------.----- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------- Septic __________-_-----_____ __-.--"-_Septic Tank (Specify Requiremertsl -------------------------------------- -------------- -------- ------------,,.--- Disposal Field (Specify Requirements) ---------- ± �-� �- � : ---------------------------- -------------------------- t 1-11-4 -- -] --------------------------------------------- - - ---- ------ ---------------------------- (Draw existing and required addition on reverse side) I hereby certify that (..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?he following: 6 "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 ----------- ----- ------ ------ Owner y BY ---- ---------------- Title " (If of a than owner} ---- ------------------------------------------ ' -._F Ai2TMENT_USE ONLY._-,—_Y. APPLICATION ACCEPTED BY .---- i - - DATE --- _ - BUILDING PERMIT ISSUED '-- -----` == '=`' �"_- °-----------------------=---------- -DATE ------ ----- .- ----------- i ADDITIONAL COMMENTS ------ -- -- -_------ ------ - - --------7 --------------•"---------- ------------- - - a ________________________________________ _ _________ _ ___._____-___- Fina Inspection by: - .1 = Date { ------------------------- -- ' SAN J AQUIN LOCAL HEALTH DISTRICT g. E. H. 9 1- 68 R v. 5M N" l