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FOR OFFICE USE: l APPLICATION FOR SANITATION PERMIT Permit No. .- -.r--% (Complete in Triplicate) --------------------------_- ---N-- 7 �G 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�JCounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 7---- Ct ------'---------------CENSUS TRACT ------ ------------------- --------------- Owner's Name __ =- Phone � � ------------------------------- Address ---- ~ City ` ` Contractor's Name -.- -]��---- -(� . :-------.License Phone 1 Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court a f ----------------------------------- 1i''----- Motel ❑ Other - ------------ Number of living units:--- Number.of bedrooms -_!&------Garbage Grinder/VP-_ Lot Size _404-1-44F f0--- f V Water Supply,;-Rublic.System_and name 4'-------------- ------------------------------ - ---------------------:f--------------------Private Character of soil to,a depth of,3 feet: Said'C7 Silt❑ Gay ❑ Peat❑ Sandy Loam:•❑ Clay Loam ❑ .. Hardpan ❑ Adobe A Fill Material ----- ------ If yes, type----------------_-_-.------ (Plot plan, showing size of lot, location of.. system in relation to wells, buildings, etc.,rnust 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 f ] Size--------------------------------------- Liquid Depth -------------------------- ._._, Ca ----------------- Capacity -aT e --------- --- ` Material No. Comp.prtments P Y '------ ----- � Yp e. P Distance to nearest: Well -------------------- ---------Foundation -------------------- Prop. Line ----------------- --- t LEACHING LINE [ ] No. of Lines ------------------------ Length of 'each line---------------------------- Total Length -------------------------- 'D' Box -----' - -- Type Filter Material --------------------Depth Filter Material --------,;---------•------- ------------•-- Distance to nearest: Well .---"------------------- Foundation --------------- Property Line ----_---_-.--_--.------ SEEPAGE PIT [ ] Depth ------- ------------ Diameter --------------l- Number --------- --------- Rock Filled Yes F] No (] WaterTable Depth ----------`--------------------------------------Rock Size -------------------------------- Distance to nearest: Well _-r_ .-- --------="....Foundation -------------------- Prop. Line ----"-----•-----•----- { REPAIR/ADDITION(Prev. Sanitation Permit# ------- -'- ---------------------- Date ----------------------------------1 i ------------ Septic Tank (Specify Requirements) ...------ / f,"ai.--------- I-- --=,----------- f�------- l - - Disposal Field (Specify Requirements) r -�--C! ----_---4 -- f - I --------- �y 9 ' --------------------------------------------- -------------- this cation and that h - -- e ----- clition on reverse,side) I hereby certify that I have prepared�t pp a work will be`,done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the'Son Joaquin Local Health District. Home owner or licen- i 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 Com ensation laws aft California✓" t ' -" Signed Owner , -------------- itle . = k T = of "er than owner sa " t �4 -leFORD RTMENT USE ONLY APPLICATION ACCEPTED B �` - ------ ---------- - DATE -- - -�-��- BUILDING PERMIT ISSUED 9"7�t� a"= 6 DAT ---- ------------------------------------ ADDITIONAL COMM,ENTS ------- ------------------------------ ..---------7=7,70 r L� ---- ,5 i� `V-=----- ------------- ------------ ------------- ------ "---- v .; -------------------- -- - - = 7 ---- - ---- --------------------------- Final inspection by. ---------- Date 7� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M