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FOR OFFICE USE: _ ' APPLICATION FOR SANITATION PERMIT Permit No. �_----__� --------- -------------------------- (Complete in Triplicate) -l�173 j Date Issue -------------- ----- This Permit Expires 1 Year From Date issued Application es 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 Count Ordinance No. 549 and existing Rules and Regulations: / CENSUS TRACT JOB ADDRESS/LOCATION _-.- -��----- -- ------ ------ = r Owner's Name _YY1 R ^�----- - - ----------- - ------ - Phone I Q Q ----- --- � --- ---=-------- • city ------------------------------------------------------- Address Contractor's Name i r - .License # �� _y Phone --- -;; Installation will serve: Residen ' •FApartment House[] Commercial ❑Trailer Court ❑ tMotel:[] Other --------------------------------------------- Number of living units �___ Number of bedrooms m - =mar-ba e,Grinder -___._._.-_ Lot Size __._ — -------•----- i �. 9. Water Supply: Public System and Iname ---------------- --------- -- ------------ ------�- ---Private Character of soil to a depth of 3 feet: Sand'❑ Silt El Clay E] Peat ElSandy Loam Clay Loam C] 1 Hardpan F-1 Adobe '(]�"-Fill Material _.__---_____ If yes,type _-------------------- ----- � W r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �.. J w NEW INSTALLATION: (No septic tank or seepage pit permitted if publicfsewer is available within 200-feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [y Size tl —d - �� f=_ No LCom Compartments v ............. r Capacity J,o?qa_ Type -- Material_.- - p a � Distance: to nearest'-Well --------------ate--©-- ---------=`_Fou.ndafion ----7p- ----- Prop. Line _.-------------------- 41 LEACHING LINE No. of Lines ---------?I----- ---- Length of each,,•line_-__._ Total Length ----ller.k' ...... D' Box ------------ Type Filter Material ----- ---Depth Filter Material -------- -------------------- ....... r =to nearest: Well _-______ - ____ Foundation ---_ Property Line Distance W _ T ' Depth __------- teeter -- -e _-- Number -------' ------------- Rock Filled Yes No iC Water Table Depth ------------- G,/'r Rack Size Imo- -----��---�------- i .Foundation _�_61`�--.-... Prop. Line _...___/r'__- Distance to nearest: Well ___.________�� '•"- � REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------.-------------------------} Septic Tank (Specify Requirements) -------------- -------------------------------:-------------------------- ---------------------- Disposal ---------------------- Disposal Field (Specify Requirements) ------------ ---------------------------------------------------------- u_'__ ----------------------------------------------------- ------ ------ ----------------------------------------- -------------------------------------- -------- - {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 ---------------- '- - -- ---- Owner �_ Title - . ------------------- -- -------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _- -- - ___. DATE -_._.-_.-�'�---_7 - ------------------------------------------------------------------------ ._ BUILDINGPERMIT ISSUED ---------------------- ----------------- --------------------------------------- -------------------- --DATE ------- ---------- ------ ADDITIONAL COMMENTS ----- ------------ -------------------------- ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------- � r --------------------------------------------- -------------- ---------- - -- -- FinalInspection by: r- G �----- Date --------------- Final SAN JOAQUIN LOCAL HEALTH DISTRICT ``LL E. H. 9 1-'68 Rev. 5M