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A .-g FOR OFFICE US£: } - APPLICATION FOR SANITATION PERMIT -------------------------------- (Complete in Triplicate) Permit No. .7 __.. k -_-_-- This Permit Expires 1 Year From Date Issued Date Issued i 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 arid existing Rules and Regulations: �+ I JOB ADDRESS/LOCATION . °�! 1-- - -- G_t ---- '---CENSUS TRACT -------------- --•-------- Owner's Name ------ ---19Z---- " Phone ,5... .__6 Address ----------�* r " --------- - - ---- - .---t---------------------------- City Contractor's Name ------------License #qZsa71_7ff- _ Phone Installation will serve: Residence.X Apartment House❑ Commercial❑Trailer Court i❑ I Motel ❑ Other ----- Number ---Number of living units:' _ _Number of be ooms __ __Garbage Grinder Lot Size __rX___X_1a6 Water Supply: Public System and name _______ �----------------------- ------------- - _____Private ❑ l #------------- Character of soil to a depth of 3 feet: Sand❑ Silt o Clay❑ Peat❑ Sandy Loam [] Clay Loam 1E] Hardpan ❑ Adobe' ' Fill Material ------ If yes,type$_____________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mus j be,placed on reverse side.) NEW INSTALLATION: (No septic tank or:seepage pit permitted•if-public-sewer>is-available-within 200 feet,) �( PACKAGE TREATMENT { ] SEPTIC TANK [ ]",(S'77;0S ie---*--------------- ---------------------------- Liquid Depth .------------------------- I % Capacity = -------------- Type -------------------- Material---------------------- No. Compartments --------- \j •+. ince ante to nearest: Well --- -----_------ ---------------.w- ---� Foundation --------------------- Prop. Line -----------.._--.----- - - -- LEACHING EINE INo. of Lines .__---�___________ Lengthtofedch line.____._ 4------------- Total Len th r 9 -----e- 'D' Box ____: _-__ Type Filter Material _AACO&------De _ Depth Filter Material ;�� --------------•------ r . Distance to nearest: Well �df�_C.el. - Foundation -----------_ Property Line. -__�_f------------- PIT, ' SEEPAGE PIT ' Depth ---vtC--------- Diameter _` _`fNumber ______ ------------------ Rock Filled Yes No i❑ Water Table DepthCf--------•-------------------------Rock Size --- ----------------------- a-- Distance t nearest: Well -----A0—_tis.&&-----------Foundation _l<I__f7J____ Prop. Line ----------- REPAIR/ADDITION(Prev. SanitatoniPermit# ------------------------------------------- Date -__-----------._.___________--•_- ) Septic Tank (Specify Requirements))----- _--------_ '-- -------- -- --, Disposal Field (Specify Requirements) --- --------------------- ------_A_ 32 ---------- -------------- --- --------------------------- ---I = .- - r --------------------------------------------------------- ------- - - - - - - - ---- -------- ----- # '�* a•r (Draw existing and required ad lition 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 the1ollowing: f "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 subiect to Workman's'Cornpen sation laws of California." r a Signed it -------------- -_-0 Owner BYr Title ----- (If other than owner) . K T I FOR DEPARTMENT USE ONLY € APPLICATION ACCEPTED BY .__._ :_ -- I - --� ---- --- --------------------- - ------ -------- DATE ---- - "------• --!NG --------------------- BUILD PERMIT ISSUED ---------=--------------- DATE -- ---------------------------- -- ADDITIONAL COMMENTS =------ -- ---_. ------- -----------------t------------------------- € - f -- ' _/ - -L----- ------------------ = ----- -- -- :----------- ----} --_ - -----------------------------------------------/-------- - ---------------------- ------------------- # Final-Inspection by; Date ;t7 - = �- - SAN OAQUIN LOCAL HEALTH',,Dl�S7li;ICT .�. E. H. 9 1-'68 f