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FOR OFFICE USE: ✓ APPLICATION FOR SANITATION PERMIT 12- i/1- Permit No. 7_27<_-_4f/-Y--------------------" - ��"---- (Complete in Triplicate) �- 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/LOCATIO_N�.1_ •_��__/� fry---------------------------------- ------ ------CENSUS TRACT -------------- ----------- Owner's Name - _ �'`' "-� QilYl- J - ----------- -------------------Phone 1146- 7!47�U---- ----- - - --------- -- ---------------- Address -------- --- 1 ------------ ---- city 11.� � Contractor's Name _�. _ :_ s----- -------------------------------------License # Phone -211 Installation will serve: Residence 4 Apartment House❑ Commercial [jT�ailer Court 0 Motel ❑ Other -------------------------------------------- .�_ d Number of living units:.____----- Number of bedrooms __�-___-Garbage Grinder ------------ Lot Size __ =p------fi ------- Water Supply. Public System and name ________________ ______ --------------------------------------------------------------Private F] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe [ Fill Material _____.__--- if yes, type ___----------------------- Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must fbe placed on reverse side.) ki ( p � 9 � NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 6 PACKAGE TREATMENT [ I SEPTIC TANK;[ ] Size------------------------------------------------ Liquid Depth -------------------- Capacity ----------------- -------------------Ca acifi --- Type -------------------- Material---------------------- No. Compartments ------ ----•- -------- t Distance to nearest: Well ------------------------------------Foundation --------------------.-- Prop. Line ---------- ----------- LEACHING-LINE No. of Lines ______/____________ Length of each line a r�- - Total Length__ -----__-- r/ 'D' Box __""�"_ Type Filter Material ---- `� _________Depth Filter Material __-______/�----------------- - Distance to nearest: Well r '"`------ Foundation Property Line -------- SEEPA"GE PIT .[ Depth -----��__-- Diameter' -A Number ----- ----/------------ Rock Filled Yes ® No 0U� ---- -------------`I'2 Water Table Rock Size --------Depth -----------�d------- ---------•-------• .. Distance to nearest: Well ______^_______ _----------- -------Foundation ___4 --------- Prop. Line EPAI ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----=----------------`----------- Septic ------- -Septic Tank (Specify Requirements) -------- ---=---- - --.-----------------' ----------- ==--------------,..--------------------------- Disposal Field (Specify Requirements) ----------- -------------------------------------------------------------------"------ -------------------------------- ------------------------------------------------------------------------------------------------------ --------------------- (Drow 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 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: _- e "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 By ---------- Title --- ------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY V__ "` Z��' DATE Z BUILDING PERMIT ISSUED = = = - ----- DAT1= --------- - ADDITIONALCOMMENTS ------------------- ------------------ ----------------- --------------=---------------"----------- ------------------------------------------ ------------- ------- - ------- -- r ---- ---------------�-`-- -- --- ---- - --- - ------ - --- ----- ----- ------ --------- ------------------ _ - --------------- ---------------- ----------- ---- --- - ----------------- -------------------- -------------- - ----- ------ -- ------------- --- -- ....ia-=fid Final Inspection by: ._ Date SAN JOAQUIN LOCAL HEALTH DISTRICT E E. H. 9 1-'68 Rev. 5M Q