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�6 2� 62a1ti,b�nJ y z 11 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------- -------------------------------- Permit No. LComplete in Triplicate) .............. ---------=----------------------•------------------------ 77 Date Issued _/ --------------------------------------------------------- This Permit Expires 1 Year From Date Issued ------- .d 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 SA^'___ATo-q 'N i` `4g-_ c�G--____�'_a._ __`�A B' CENSUS TRACT .f ' ' Owner's Name ---- ----- i4 e p--------------------------- _- -------Phone ----------------------------------- Address ---3QQv a,_ ---------- 'A S S a N ------ ------------------ City --T-?- oq_!-i y---------------------------------------------•----------- Contractor's Name __ __/4N _ _d_N !______-f___SQ_N ._____._:______- License # _�db _S"g6--_ Phone �A3' `f'.f"'S .................. Installation will serve. Residence ®Apartment House❑ Commercial []Trailer Court ;❑ Motel ❑Other ------------------------------------ ------ Number of living units:---I------- Number of bedrooms __________Garbage Grinder ____________ Lot Size S"O- -— ---BUD--------------------- Water - _ _ -Water Supply: Public System and name ---s i_ (__ <___ .'--------------------------------------__--------------------_-------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 1K d� Hardpan ❑ Adobe ❑ Fill Material ___________ If yes,type - (Plot (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �t NEW INSTALLATION: (No septic tank or seepgge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size___ ____41* ��__ �__________________:____ Liquid Depth __.__:'__�___........_. Capacity _1_40_b__„__ Typefrlylaterial-_-1�OpPG,---- No. Compartments ................. Distance to nearest: Well _______ .�� ..._._.... Foundation _____�_d ___ Prop. Line ___ . ____ _______........_ Lengh of each line_____________________-____ Total Length -----------_. - LEACHING LINE � . No. of Lines t3._.t3 �L �y C g - ------------- D' Box ___ ,____ Type Filter Material _NROOXDepth Filter Material -___ __y_�------------ ----------- Distance to nearest: Well __ Foundation _ s_------------ Property Line ........................ SEEPAGE PIT [ ] Depth ________________ Diameter ________________ Number -------.------------.------ Rock Filled Yes 'Q No Water Table Depth ------------------------------------------------Rock Size -------•------------------------ Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ------------------------------------------------------------ ---------------------------------------------- •.-----------------•---------- DisposalField (Specify Requirements) -------------------•--•---------------------------------------------------------------------------------------------- ---•----------- ----------- --------------------------------------------------------------------- ---------------------------------•----------------------- (Draw existing and required addition on reverse side) 1 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.” SignedA.AmTh-ow- 'f -----Soil/---------------------•-------------- Owner By - Title ------------------------------------------------------•----------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ________ =__ DATE __- __-____,c_ BUILDING PERMIT ISSUED ------------/--- i� - -------------------------------------------------------------------------' - - - -DATE ------------------•---------••--'-•---•--- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------- ---------------------- ----------------------_--- ----------------- -------- -------------- ------- - - -- ------------- - ----- --- - '--------- --------------------------------------------------------------- ---- ------------------- ----------------------- --- -------- -- - -- --- -- -------- --- --------------------------------- = ---- - ----------------- --- --- - - - - Final Inspection by: �'E Date f SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rrgi