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yFOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- -�7 (Complete in Triplicate) ---------------- ---------=---------------------------------- - Date Issued --------------------------------------------------------- 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 ._____ 1/-Cf 1_ -e—";�______/��___-��__0,#_C°%--q-_l � / f �/ .�, _ _CENSUS TRACT __________________________ Owner's Name '�+._�4_h ti -------------------------------------Phone- -0��6 �/ f� ` , Address30-o-a_-_'_�_--- SG�!Y Fes%- �U City _ W -- -- - - - ------ - - - - Contractor's --- Name _-6 ___..C4-_/_`�_ _�_I ____-_--_-____________________.License #9� c��:]-__ Phone Installation will serve: Residence m Apartment House[] Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:------------ Number of bedrooms --,#Z._..Garbage Grinder _- ---- Lot Size . �- --� d________________ Water Supply: Public System and name 4NW_� v11W----lZl-_�"_E'/z---&P-A-----�!� `�fL., s' �s�Private ❑ Character of soil to a depth of 3 feet: Sand'❑ S71t❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe"❑ 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.) ro NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) M �0 PACKAGE TREATMENT [ ] SEPTIC TANK;[ ] Size______________________________ ____________ ____ Liquid Depth ________--.____-____------ 9 Capacity TYPe - ------------------ Material------------- -------- No. Compartments --- •-----...... -S Distance to nearest: Well _ ---------------------------------Foundat on ---------------------- Prop. Line ......................ro LEACHING LINE [ ] No. of Lines ------------------------ Length of each line------------- -------------- Total Length ----------- ................. 'D' Box ------------ Type Filter aterial ___________________Depth F Iter Material ............................................ 4' Distance to nearest: Well __ ____________________ Foundation ------ ----------------- Property Line ----------------- ------ V SEEPAGE PIT [ J Depth ____________________ Diam er ________________ Number ---------- _________________ Rock Filled Yes ❑ No 0 Water Table Depth ----------- ----------------------------------Rock Si -------------------------------- Distance to nearest: Well __ --------__________________________ _Founda ion -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# _________ _________________________________ Date _____ ----------_________________) Septic Tank (Specify Requirements) -------------------- ------------------------------------------- - - --------- ------------------------ Disposal Field (Specify Requirements) ------------ --------------Y----------------------------------------------------------------------------------------- --------------- W --------------------------------------------------------------------- ---------------------- . ------------------------------------------------- ---------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workm 's Compensation laws of California." Signed -- ----------------------- ------------------ Owner d? BY -- ------------------ Title ---- -------------------------- --------------------------------------- (If other than owner) FOR DEPARTMENT LIE ONLY APPLICATION ACCEPTED BY------------------- -----------------------/----- 1 ' DATE ---/7.4 -71-- --- ----------------- BUILDING PERMIT ISSUED --- ---------------------------- -- ---- -------- DATE ADDITIONAL COMMENT _ ---------- `' ------------------------------- c = rte _ = i _: ----- L------------- ------------------------------------------------------------------------------ ---------------------------------------------------,--------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- - Final Inspection b P Y - --1----------Date --- ------------------------- SAN JOAQUIN LOCAL HEALTH STRICT E. H. 9 1-'68 Rev. 5M C C/