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FOR OFFICE USE- 0-0 "' APPLICATION FOPia SANITATION PERMIT -2 l � c „ � Permit No. - p D. -7------------ �s ------ (Complete in-Triplicate) --------- -�F'----------------- Date Issued -------- ------- -------------------------- - -- This --- Permit Expires 1 Year From Date Issued Application is hereby made to theSan 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: a 1`!a 17 I ..._CENSUS TRACT ----- -------------------- 4 JOB ADDRESS/LOCATION .___. -- -- , -Phone ------------------------------------- Owner's Name •1 (j 64 I-- ------------------ City �t 7�_�`-_-------- Address -------- ---- Contractor's Name -------------- --------------------- ------- --------------------------------------- License # ------- ----------------- Phone + Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 10 l Motel ❑Other --- ------------------------------ f k 7$/----------- Number of living-units:-----l---- Number of.bedroom _ _-- - arbage Grinder ------------- Lot Size ------------------ --- Private El Supply: Public System and name ______- - Character of soil to a depth of 3 feet. Sand❑ Silt F-1ClayPeat Sandy ---------------------- Loam ❑ Clay Loam El Hardpan ❑ Adobe' FIII 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:} % L seepa a pit permitted if public sewer is available within 200 feet,] r NEW INSTALLATION: (No k or PACKAGE TREATMENT [ ] ANK'[y Size. ------------------ Liquid Depth --- ------------------ r ��_ Material.�� No. Compartments - ---------------- x Cap _ L' _ l `\ Distance to nearest: Well e __ --- - - ------Foundatio� �1_.-- --- -- Pro Line - -- - i � LEACHING LINE [ ] No. of Lines ---- ---- Length of each line--_-- ��------- Tota! Length __ __a _��------ ` C� Yp Depth Filter Material ----�- --�- ------ ------------ -- 'D' Box ' __. 7 e Filter Material R� --- y� Distance=to nearest: Well Wg_f.it AX-s Foundation _t� --.-- ==: Property Line ___ __________________ r Rock,Filled Yes ` No f❑ I Depthl Diameter Number ------ ='� SEEPAGE PIT [ ] le Water Table Depth 0 -------------------- Rock Size ��. l (� Lc1Z,[X.S Foundation _ZO ------ Prop.,.line ----4---------------- Distance�to nearest: Well _�________ REPAIR/ADDITION[Prev. Sanitation Permit# ----------------------------------------- - ----Date ---------- -----------------------} I ------- -- ----------------------------- Septic Tank (Specify Requirements} ----------------------- --------------.-----------.---- Disposal Field (Specify Requirements) _--------------------------------------- - ---------------- ---------------------- ------------------ ----------- -------- ---- -- - . - - ------.----- ----k ------------ ---------- --- -------- ------ (Draw exisfiing 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- 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.Wor man' P Com ensati.on laws of California.” y Signed '= Owner __ ---------------- Title -- ---------- --------- -------- ---- (If other than owner) FOR DEPART ENT -USE ONLY APPLICATION ACCEPTED BY --- - -- ----------------- --- ------ ---- ------------------------ DATE 11-7 _ 7 BUILDING PERMIT ISSUED ------- ------ -- ----------------------------DATE --------- ----------------------------- - -- ---------------- _ ADDITIONAL COMMENTS ._..-�-�------- ---- --------------------------------- ------------ ------------------------ --------------------------- -- ----------- --------------------------- --------- Date - ----- --- -- - ---------Final Inspection b SAO JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 R . M