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FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT S ---------- ->: . ------ (Complete in Triplicate) Permit Na. -��__-____. _ .. ------ ______________ ` This Permit Expires 1 Year From Date Issued 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 /----- --- 3-,Cn-------rn� _--/`/9-YC-f7------/ ._�/_---------CENSUS TRACT --------------•-----• - Owner's Name f-_ - NS6---------•C%G':``!1i_-Ci ------------------------------- -------Phone Address ------------- _3 --------��'---- "T C -----�d. City TY^-C 7 - Contractor's Name ------------------------ - ------------------------------- d = License # Phone Installation will serve- Residence ❑ Apartment House-E] Commercial:❑Trailer Court ;❑ I Motel ❑ Other ---- Number of living units_____________ Number of bedrooms Garbage Grinder ------------ Lot Size ----------------------------------- ........ 1 i Water Supply: Public System and name ------------------------------------------- ----------- ----------------- -------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt J] Clay ❑ Peat EJ Sandy Loam❑ Clay Loam :❑ 1Ha�dpan 'Adobe❑ Fill Materials ------ ----1f yes, type ---------------------------- 1 (Plot plan, showing size of lot,jo a,tion.-oUystemein relation to"wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if; public sewer is available within 200 feet,) ` PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------ _____________ ----------------------------- Liquid Depth -------------------------- ---- Capacity -'- 1------------ Type -------------------- Material....................- ---- No. Compartments ----- . ........... V # Distance to nearest: Well ----------------------- ----------Found tion -----------------rProp. Line --------------------_- LEACHING LINE [ J No. of-Lines ------------------------ Length -of each line-• --------------------- Total Length 'D' Box Type Filter Material ________i_,_= Depth Filter Material Distance to nearest: Well ------------------ � F�oation ------------------------ Property Line ------------ SEEPAGE PIT [ ] Depth ___-_ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth --------------------------------- ----------I---Rock Size -------------------------------- Distance to barest: Well ________________________________Foundation __.----------------- Prop. Line ________..___. ----.- � REPAIR/ DITION(Prev. Sanitation Permit.# --------.----------------------------------- Date ----------------------------------) isTank (Specify Requirements) --------------- ----------------------------------------------------------------- ----------------- - - ---•/----------------- Disposal Field (Specify Requirements) --------CsF® --------�� --- � � �f�_�_ ----____f�f�--- ------------ --------------- ` y �$� s �h' o-------QX-- J�s—-------.5rs i ----------------- ------------------------------ ---------------------------=------------------------------------------ --_-------------------------------------------------------- -------------------------------- (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: w "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 ---- / .-- -- 4thd � -- .......---- �------S�a--I`l--------------- Owner 7Y-,4 BY - - ------- ' ---- ------ ---• --------------------- Title ------ .�.t __- e T f other r f FOR .DEPARTME T W ONLY APPLICATION ACCEPTED BY ------------------------------------------ ------- ------- DATE _._ - -- ------------- BUILDING PERMIT ISSUED ----- ----- -` -------- --------- DATE ADD17lONAL COMMENTS - ------------------------------------------------------------=-------------------------- Final Inspection b Jrr ------------Date ---- -- �� P Y� ----------------- ------ --------;--------------------- -.- ------------------------ •------------� - - - - - - --------- -------------------- SAN JOAQUTAOCAL HEALT ISTRICT "7 E. H. 9 1-'68 Rev. 5M Q ,a