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FOR OFFICE USE: r,: AgPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 6-- 9---- ----------------------------------------------- ------------------------- This Permit Expires 1 Year From Date Issued Date Issued __?Pa__.. 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 rdinance No. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION .- /- Ll�Yl -'---- --------- ----- -- -- - ------- ----- ---CENSUS TRy�ACT ----- ...-------- Owner's Name ------ ----------- -------------------Phone/__� _.' 5-�------ Address ------ 13 a_6 �-------- --- - ----- - - ----�'X1�E y Contractor's Name ____________i_____ ------- ----------License # ---- Phone 44-%617 Installation will serve; Residence XApartment House-E] Commercial ❑Trailer Court i❑ a Motel ❑Other a.•'` Number of living units:____/_____ Number of bedrooms __ ____Garbage Grinder Lot Size. .jQ, pp y �-7� Water Supply. Publics stem and name _______________ - ' Private ` - ---------------- ----------------- Character of soil to a depth of 3 feet: .. Sand'0`4�Silt❑ Clay [ Peat❑ -Sandy Loam -E] Clay,Loam ❑ Y). ,, i % . Hardpan- ,Adobe Faterial-- ---------- If yes, type ---------------------------- (Plot plan, showing size of lot,-,location of systemtiin•relation -to wells, buildings; etc.-must-be.placed- on reverse side.) N ' ''i ' (No septic tank or seepage pit"permitte NEW INSTALLATION: d if public sew& is available within 200 feet,) W PACKAGE TREATMENT [ SEPTIC TANK l `' ,f � 7 � 5#ze-��-- - �=°s----------• --------- ---- ----- Liquid Depth --------------------...-. � Capacity --------------------- Type ------- --'----ti ----------------------- No. Compartments Y Distance to nearest: Well -._____ __°f'__.- � -----------Foundation ______________.____-- Prop, Line ---------------------- LEACHING LINE [ ] No. of Lines _______ ________________ Length of each line---------------------------- Total Length li 'D' Box ------------ Type Filter Material________________.. ____-Depth Filter Material ____--_____-_- -----•-•---------------•---• Distance to nearest: Well ------____ ---------- Foundation __________________ _____ Property Line _ w .w SEEPAGE PIT [ ] Depth -------------------- Diameter _�- F-- .c /Number ----------.--------------.:-,Rock .FiEled Yes.[].. No ❑ Water Table Depth t I ---- - --------------------------- ------ ---------- j -_-_ Distance to nearest: Well __- ___-__-_ ___R__- ----------Foundation ► rop. Lin? REPAIR/ADDITION(Prev. Sanitation Permit# = _ Date ; ; ------------ -----`-I 4 � - --- c . Septic Tank (Specify Re uirement$ Dis osal Field (Specify Requirements) -__- ---_ __ II' I 1 I f �� ------- ---------- `_._--- 15"x-y --------------------------------------------------------- � _ �. . (Draw 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-It Joaquin Local Health District' Nome owner or licen- sed agents signature certifies the following: � "I certify that in the performance.of,the work for which this permit is issued, 1 shall not employ any person art such manner as to become subject to Workm n's�ompensati.on laws of .,alifornia." -- ---� Signed -- -------=- ---------- ----- # I Owner ! ------ ------- ---------------------` (I oth an owner) --- �/ _ -------------------------------------------- O EPART ENT USE ONLY APPLICATION ACCEPTED BY----_ �I _______________ DATE --- - _ - --- - ------------------ BUILbiNG PERMIT ISSUED ___ ---- �.-- ------- Z( ADDITIONAL COMMENTS ---- -- - - - - - -- - :1 ---7! -------- --- DATE ----------- --------------------------- ------- h_----- -- -------------------- --------------- --- - -- -------------------------- --------=- ---------------------------------------------------------------------------------- - - --- -- ---- - --- - ------- -- Fina Inspection b � .-- P Y ------ k-------------------------------------------------Date _,77--- -.- G '1l Ev ---------- A IN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. M