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FOR OFFICE USE: ._ . APPLICATION FOR SANITATION PERMIT x (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued Date Issued ---07:_/:__Z:L` 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 mad` in complia e with County Ordinance No.,549 and existing Rules and Regulations: JOB ADDRESS/LOCAT ON .-CENSUS TRACT ----------------------_- Owner's Name -.0 �/ -----. * i, ---- Q.-- ,f --------------------- ---- --------------- Phone ._74,1'696--��--r�---- Address Af" -_--- r------------------- - City ----- f-. c - ----------------- Contractor's Name �_-st�l_ �T�C _ ------------ -------License #a _ _7 __._ Phone 14"J-7 4V-2j 4 Installation will serve Residence ❑ Apartment House Commercial ❑Trai�leir Court ] Mote! E] Other - - ------------ -�-��1✓___.� � �` Number of living units-------------- Number of bedrooms ________-_Garbage Grinder ------------ Lot Size _._____-_________________________________ Water Supply: Public System and name -----------------------=--------•------ ---------------------------------------------------------------------Private ❑ ' Character of soil to a depth of 3 feet: Sand'[] Sift❑ -_ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam IHardpan D Adobe'© Fill Material ___________ If yes,type __"®_______________ r � (Plot plan, showing size of lot,`location of system in relation to_ wells, buildings, etc. must a place on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available withinV feet,) PACKAGE TREATMENT ( ] SEPTIC TANK'y Siz .7_y y 'r Capacity.aQo._____,-- Type _ ----- Material__ 4:�..y __ No. Competnl�nts -._ ----------- AL Distance to nearest: Well __--_ -(� _____________________Foundation ___ t?_______---__ op. Line ----/a--`-__._____ LEACHING LINE [ ] No. of Lines ----- ------------- Length of each line-y Q-------------_--- Total L tri, __, "r�_.-•••-•---_--- i P 'D' Box 1-3.... Type Filter Material " __�.or' �_'Depth Filter Material ----�i�_ -_____----------------------- Distance to nearest: Well ----,lw--------- Foundation �eo--------------- Prop i e ---f2_--------- _____ SEEPAGE PIT [ ] Depth _________________ ___ biometer Number -----------------------f _ ock Filled 'Yes E] No C]I Water Table Depth ------------------------------------------------Rock Size ------ i -----•--• ----------- i� Distance to nearest: Well ----------------------------------------Foundation ------- ------ Prop. Line -----------........... II REPAIRfADDETION(Prev. Sanitation Permit F# ____________________________________________ Date ________________._________________) 1 4 I Septic Tank (Specify Requirements) -- .------------------------------------------------------------------------------ ----------------------------- r � Disposal Field (Specify Requirements) ------.:----------------------•------------------------------------------------------------------------------------------------------- -------------------- ---------------------------------------------------------------- -------•------------------------- --- -------------- - --------- -------------------------------------------------------------------------- --------------------------------------------------------- (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 tttoo�Workman's Compensation laws of California." Signed�a._i - s1Y------------------------------------------ Owner I l r By ----- ------------------------- -----------------`-.................................................... Title ---- -------------------- (If other than owner) F FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY - - ....__y---------------------- DATE --------��= 7� BUILDING PERMIT ISSUED --------- I------------------------------------------ - - ------ ---------------------------- ---DATE ----- - - -------------- [ ADDITIONAL COMMENTS ------------' -------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------7-------- ---�--------- -- -----. Final inspection by: _ -- ------- --- ----------------------- -Date -Z q f E. H. 9 1-'68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT G� r - �