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fl FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------- Permit, No. ------%_-1-- (Complete in Triplicate) ---------------------------------------------- Date Issued _cQ--------------/ -------------------------------------------------- This Permit Expires 1 Year From Date Issued ii 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: ,I J� � -- 1 - ------GENS S TRACT -------------------------- ' JOB ADDRESS/LOCATION3 --.- �- _ Owner's Name .-- QL_L, hS1---1---Q-------------------------------------------------------------------------- -Phone --_--_ -s------------------------•----- City Address ----- ----------- i Phone ��1�Contractor's Namem �� ,----- --------License #7� 17 } Installation will serve: Residence (Apartment House -1 Commercial ❑Trailer Court :E] �x Motel Number of I vin units: - ---- Number of bedrooms-3_--_-_--Garbage Grinder JNLo--,- Lot Size T_ - --------------------------------- JLL Water Supply: Public System and name ---------------------------------•-----------=------------------------------------------------------------- --Private Character of soil.to a depth of 3 feet: Sand' Silt Clay Peat Sand Loam Cla Loam iE P ❑ ❑ Y ❑ � ❑ Y ❑ Y ❑ Hardpan ❑ AdabeX Fill Material ____ ------- If yes,type ----------_-- --7+ (Plot plan, showing size of lot, location of system in relationl to wells, buildings, etc. must be placed,,"',on reverse side.) O ,1 ' NEW INSTALLATION: (No septic tank or seepage pit-permitted if public sewer is available within 200 feet,) . PACKAGE TREATMENT { ] SEPTIC TANK{ ] f Size--------------------------------------------- Liquid Depth p h _....__.------_-_.____-_-- Ca aci` � T � e _____________ ---Material Foundation,___--No---- _ Prop. _____...-------_=•--- P lY ------------------- YPCompartments �* Distancae to nearest:,Well ------------- - --- ---- Total Length Line ------------..-------- li ., r' LEACHINGLINE { ] No. of Lines ------------------------ Length of, each cline------------.----------- g _____.----.---------------- _ . Type Filter Material Foundation th Filter Materi Pro er Li ' r 'D' Bo x ._----- -- -----=------ -------------------------------------------- 'Distance .----------------------------- 'Distance to nearest: Well;'-- -----:----- Property ne ------------------------ 1 SEEPAGE PIT [ ] Depth ----------___--..__...Diameter.,---------------- Number ---------------------- Rock Filled Yes ❑ No 0 �— $ Water Table Depth -------------------=----------------------------Rock Size -------------------------------- Distance to nearest: Well ---------------------------------------- -------------------- Prop. Line ------..__....--__..__ ' REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------.------I 4 ! Septic Tank (Specify Requirements} -- - ------------------------- -------•--------------- r la Disposal Field ;Specify Requirements] --------- {�"� 1 1 � ' --- I` ----------------------------------------------------------------------------------------' ------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I 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 t in the performan the work for w c jthisperit is issued, I shall not employ arty person in such manner as to beta a subject too ork Co/ pins wsrnia." Signed Z44X---------------- By ------------------------------------ -------------------------- ---- Title /� (If other than owner) FOR DEPARTMENT USE O LY Wit_. DATE �' �� APPLICATION ACCEPTED BY ------------------------------ r�--`°-�-•------------------- ------------------- ------- - --- ---------- ------- ------------ --- - -- - BUILDING PERMIT ISSUED ------------------------------------ ---- DATE °a ADDITIONAL COMMENTS ----------------- ----------------------------------------------------- --`------------------------------------------------------------------------------------ ------------ -- ------- ------------------------------------------------------------------------------ ---- ------------------------.- ----- -------------F-------------- - - - ---------------------------------------------------- ---------------------------------------------- ----------- ---------- -- ------------------------------------ --------------------------------------------------------------- --- ------`- -------- --• -- ---- - ---- ---- ------ Final Inspection by: ----------------------------------------- ------- ------------ •-- --- k - -------Date ---- r__1 -- --- SAN JOAQUIN Iwo L HEA' DLfS RRIICT II E. H. 9 1-'68 Rev. 5M {-- 4''S.w