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FOR OFFICE USE: �-; APPLICATION FOR SANITATION PERMIT t Permit Na. - ----- ---; ---------------- (Complete in Triplicate) 73 �-----------------�� p / ; Date Issued _ ----- S___. 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/LOCATION -------- ---------W------ y a f ---------- ----------------- ---- -CENSUS TRACT ---------------------... Owner's Name ----- --15-U-- �----------------------------------------------------- Phone ---91V CYAddress -------- ------------- ------------- ---------------------------------------• y ----- Contractor's Name _ -a__C_ a d�4---- - - a C.-------Toux ----------.License # -�f?�-�/--- Phone Installation will serve: Residence [X Apartment House�M Commercial ❑Trailer Court ;❑ Motel ❑ Other ------------------------------------------ - Number of living units ----- Number of bedrooms ________Garbage Grinder ____________ Lot Size ------ ------- Water Supply: Public System and name'--%------------------------------------------------------------------------------------------------------ -Private [4 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam b Clay Loam ❑ Hardpan ❑ Adobe ❑ - Fill Material ------------ If yes,type ---------------------------- (Plot plan, showing size of lot, location of systemin relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION. {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 4 PACKAGE TREATMENT J ] SEPTIC TANK'[ ] '� Size---------------------------------------------- - Liquid Depth -------------------------- W Capacity -------------------- Type------ -------------- Material---------------------- No. Compartments ------ --------------- Distance to nearest: Well ----------------------------_ ----Foundation ---------------------- Prop. Line ---------------------- Z .�" ------------ ------------- line------- ____ Total Length --- ----�--j---- D' Box ____/_____ Type Filter Material ------ ----- --Filter Material ------- .f-Q-��-------------------•-i 0 Distance to. nearest: Well _,_.S_OQ, „Foundation __ _�_- -___.__ Property Line ___.F/ -------- ..-- JC SEEPAGE PIT [ja Depth _ Diameter _______________ Number- _____�__.___-----__ Rock Filled Yes ® No i❑ f Water Table Depth -------------47a ------------------------Rock Size -------,--- - ----------- --- 1 Distance to nearest: Well ------ _Q _-------------------Foundation .,14;j---------- Prop. Line ...... --------- REPAIR/ADDITION(Prev. Sanitation Permit# -------.----------------------------------- Date ______-__-_--_______--------------1 SepticTank (Specify Requirements) -------- -------------------:-------------------------------- ------------- .;------------------------------------------------------------ Disposal Field (Specify Requirements) _____ � � -•--------------- -----------------------------------------------------------} ----- - -------------------------------------- /� ----- Draw existing and re'q' /norn - � r----- uired additi reverse side) 1 hereby certify that 1 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: "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) TMENT USE ONLY APPLICATION ACCEPTED BY ------ - ------ - --- --- --- - ------------------------------------------------- DATE �Q= ---------------- BUILDING PERMIT ISSUED DATE ---------------------------------------•-- ------ -- ------ - - ------ - ---------- -- A�fONA OMMENT ------ --- - ---- - --- -------- - - ---- -------- - -r --� -----� -� -------------- --- - - - �---�---� __ / ---------------= ----- - -------------------- --------------------------- --------------------------------------------- -- ------- -- ------------------ ------------------------------------------------------------------ --------- --------- - Final Inspection 6 --- - ------ •---------------------------------------Date4 N JQIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Re . M ,�