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a FOR OFFICE USE: t, APPLICATION FOR SANITATION PERMIT qq ------- -- -- - -'7" --- Permit No:��:L_ _. 0 Lsr [Complete in Triplicate] 11 - This Permit Expires 1 Year From Date Issued----- Date Issued Application is hereby made to the San Joaquin Local Health District for a permW to construct,and install the work herein described. This application is made'in compliance with County Ordinance No. 549 and existing Rules and Regulations: 27( �g o15�P -----------�_0----- JOB ADDRE55/LOCATION _-- -� _._ __ --1 r _fl. .S--._ __._CEN5U5 TRACT ____�___-_�l.�______ Yom_ / _ 1____�JYr -' 5-12 _ �; /i 6' Owner's Name ---- 4- '--- r -----------------------------------Phone ------------------------------------ Address ------A04V-1------- `SI'&x/� ----------A--1-� c--------------- �g[ �i�� v ---------- --- ------. City --------- ----- ---'-------------------------------------------------------- Contractor's ----------------- - Contractor's Name Zt. _ :Z -5a - ------- /r4- r� '7 3_ :/ ``J License # - ...... Phone Installation will serve: Residence [R Apartment House❑ Commercial ❑Trailer-Court ;❑ . I Motel ❑ Other-------------------------------------------- 1 !Vv / ff 'r Number of living units:------ Number of bedrooms ___a_____GarEjage Grinder __ __--__ Lot Size ____________________________________________ Water Supply. Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet Sand 4K Silt❑ Clay �❑• -Peat[] -Sandy Loam'❑ Clay Loam'EJ -Hardpan ❑ Adobe'❑ Fill Material ---__ O__ If yes,type—___ ----_----------- .__ �--� (Plot plan, showing size of lot, location of system in 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,) f PACKAGE TREATMENT [ ] SEPTIC TANK[ ] # Size----------------___________.___-_______--___.__ Liquid^Depth ---------------------------J Capacity --'.1--------------- Type -- ----------------- Material--------- ------------ No: Compartments ---------- •. Distance toi nearest: Well -- --------------------------------Foundation _i------------------- Prop. Line ---------- -_-------04 LEACHING LINE [ ] No. of Lines ________________________ Length of each line:_______________ ___;-Total Length ---__.__-_-_-..._-........ i 'D' Box ------.----- Type Filter Il� terial --------------------Depth Filter Material ---------------------------------------------- rn Distance to nearest- Well er----------------- Foundation _____________ :____.___ Property Line ---------------_ ___-_____ ` F � l� SEEPAGE PIT [ ] 9 Depth ------.�_--_ -' - --------------- Number __"--""__-�-= --,-___-- Rock Filled Yes ❑ No i❑V Water Tablet Depth ------------ -----------------------------------Rock Size ------------------------- Distance -------- --------------Distance to nearest: Well __ ____________________________________Foundation ------------------- Prop. Line ---------------------- :� r REPAIR/ADDITION{Prey. Sanitation Permit# __________ __ ___________________________-_ Date ----------- - ------------------- _ Septic Tank (Specify Requirements) ----------------------- Disposal Fie d ]Specify Requirements) _ _ __ . ---------T__=. _/-✓_ rff �' "'� AA A61�' A'- � ��' '� • 'y - - ------------------------------ - ---------------------- - ---------- Jlf -- t (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 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 ------, c ---------- - - Owner ` B >C._ - -Title ---- I&I'/ � ---------------------------------------- {If other birowne FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-----l_71:- %_O-------------------------------------------------------------------------- DATE ----I��'rr�- ----------- BUILDING PERMIT ISSUED ----- ------------------------------------------------------ ------------------------- ------------DATE ---- --------•----------------------------- ---- =- ADDITIONAL COMMENTS . - ---- ----- ---- -- -------------------------- --- ------------------ ------ -- --- ---- -- ;e-4- - _9___ --------------------------------------------- Final Irys ------ ----- ------- ----- -----=-------------------------.Date -- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68.Rev. 5M,