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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT C --------------- --------- ----- --- ) Permit No. (Complete in Triplicate) Date Issued /�`":�=��:-� This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Loc alth ' trict for a permit to construct and install the work herein described. This application is-made in compliance Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/L TIO -Kc`-- L -------------0 -"P --------CENSUS TRACT ---------------- --------- Owner's Name --- -._ Phone.- ---- ------ j_$ �Pz" IYY - ------ --------w' -- ------------ --------- Address ------ t. ' _,. C � `- , . , , Contractor's Name - License # - ----- Phone'---------------------•-------- Installation will serve: Residence Apartment Houses❑ Commercial :[]Trailer CourtW. ;❑ Mate) ❑Other ------------------------- - -------- W . Number of living units:.-.--_�-_-- Number of bedrooms ----------Garbage Grinder _�! --- Lot Size ---- �I Water Supply: Public System and name -------------------------------- ------------------------------------- Private`�l- Character of soil to a depth of 3 feet: Sand'❑ ❑ Clay ❑ Peat ❑ Sandy Loam C] Clay Loam ❑ -4. ;. _ Hardpan Adobe ❑ Fill Materia! .-__ ------- If yes,type ----------------- -------- (Plot plan, showing size of lot, locators of system in=relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa e'p.it,,permittecl•i# ublic sewer is available within 200 feet,) ' ' ' / Q :,r- _ .Sizes -'./ / ----X----�---------- Liquid Depth PACKAGE TREATMENT (_] SEPTIC TANK.j - �c'''-8 p y`�......... Q " _ Capacity O d - Type --- Material___; ._ Na. Compartments Distance i- nea t: Well -----4'o-`_`" --------------Foundation -------L_ea__`_----- Prop. Line ------�-- --------- � . r Q LEACHING LINE [']/ No. of Lines __ ------- Length of each line:�4 .. ca_`--____---_ Total Length_"_ a- ------------- `D' Box - Type Filter Material r5 =--_--_-Depth Filter Material ----1f-------------------------------• �Q Distance-t -nearest:-Well- Q---=-- ---- Foundation ------��----- ----- Property Line ----- -..--------- P (r ' ,�- Rock Filled Yes � No . SEEPAGE PIT (if/ Depth � - °T Diameter --- ------ Number =-------- ------------ - - Water Table Depth ------ t'-Yp -------- ------ ------Rock Size Distance to nearest: Well•:--=--- Foundation -.--- -----___"-• Prop. tine -•----- ------•---- REPAIR/ADDITION(Prev. Sanitation-Permit#--------------------- - Date -,--------------------------------- ------------------ 1 ;3 ` $ Septic Tank (Specify Requirements) --------------------------------------------------------------- -- - Disposal Field (Specify Requirements) ` - - ---- ------ Draw existing arfaa 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 to Workman's Compensation laws of California." Signed ___..-. Owner ----------------------- ,�J Title N ---------------------- --------- BY ----- '� --- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY."-- -------------- --- --- -----. DATE.._`_..,--w-----• ----------- ----- -- -- --- --- - ------------------------------------------------------ BUILDING PERMIT ISSUED ---------II---------------------------------------------- -----------------.DATE ---------------------------- ------------- ADDITIONAL COMMENTS --.-------`' -"-- ---------- --------- ------------------- ------------------------------------------------- ------------- t ------------------ -- ----- -----X` ' Final Inspection by: - . -_ ---- Date --------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT k E. H. 9 1-'68 Rev.-'5M