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AOR oFF[cE use., APPLICATLON FOR SANITATION PERMIT Permit No. 5 ��y ---------- Complete in Triplicate! .... _ Date issued This Permit Expires I Year From Date'.lssered ; r 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 Regulotian$- l7 s ...................... JOB ADDRESS LOCATION -/.�� . \ . .. V il.. ------ .......Phone � � - �`f l ....-- Owner's Name( I��xl �!_CP� If_ �..__ ...... Pe .�m,1 ..._/9 ..city 11197". ....._...•----•-=--- .............. Address ..................._. ' License ..: Phone _� 7 Contractor's Namerf� Z Installation will serve: Residence Q Apartment House f� rcial Trailer Court f] Motel [3 other-. .. Number of living units_____________ Number of bedrooms Garbage Grinder Lot Size -------------------------------------------- Water Supply: Public System and nd1 ►tte ........................................................._----•-----------------------------------------------Private ❑. � 1 Character of soil to a depth of 3 feet: Sand ). Silt Q Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 _ :- ' 1.14ardpan Q Adobe 0 Fill 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.) (n NEW INSTALLATION: (No septic tank or seepage .pit ,permitted if public sewer is available within 200 feet,) t � o Size-1, - ---K- .----- _._t... Liquid Depth .... :. .._•....,...__ PACKAGE TREATMENT I SEPTIC TANK i ] Size_ ,ll'' �+�__ Material....................... No. Compartments ..AL.............. Capacity,Yto .- TYpe !...--- Distance. to nearest: Well o� ._.Foundation p• ----_-•----•- .... Pro line �-------------• LEACHING LINE [ ] No. of Lines ----- ------•••-•--••. Length of each l€ne-- ,-�----------••• Total Length .... �?n• . V Box 9 Type Filter Material -Pex-.44,dN t filter Material ....... ___. '? to 2..............•--- Distance to nearest: Well .... .:f------ Foundation ---... ............ Property Line --.:��--•'---• SEEPAGE PIT ( � Depth __.--. Diameter __><.... -. Number ....................�---... k led Y No [] Roc Filled es Water Table Depth ....... is stock Size ....- ... 554----- + I ._Founds#ion .... Prop. line Distance to nearest:.Well 3 - REPAIR/ADDITION!Prev. Sanitation Permit ------ Date .................................. ......_..........---...--••-•------ Septic Tank (Specify Requirements) ---•---.:...........................-------....... --------'-... - Disposal Field (Specify Requirements) ------------------•-•---------•----------- --------- I ------------------------ ----------••-•-------•. -----•-----• ••....... .....-----••----_.. • ------------ ------------ ------•-- ----_----..... --------•--- y A _ - ; - — °r ----------- ................... .............. .-----------••--------------••------------•----.......------.._..---•-----........ ......,...._..._- • (Draw existing and required addition on reverse side) Thereby 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. Hance owner or licen- sect 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 n►anner as to become subject to Workman's Compensation laws of California." I Signed _.. - Owner Title ---- f other than owner) FOR DEPARTMEWT USE ONLY APPLICATION ACCEPTED BY -- :i - __ . :.. -------- ........DATE......- P BUILDING PERMIT ISSUED D ADDITIONAL COMMENTS ---• --- ' ----------------------------------•- i ----- ----------------------------- -----------= -----------------------•------------------- - ............. ............ -------•------ ------------- ------....- -•----•----- -• -----•---... Final Inspection 6y: -------- _._ _. Date --.---- -_ � . . ._... f ' EH13 .24 1-68 57�I SAN JOAQUIN 'LOCAL HEALTH DISTRICT 8/74 3M.