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R r FOR OFFICE USE: APPLICATI.0-7N SANITAIION PERMIT 4 Permit No. __ �;"?Z� -------------------- (Complete in Triplicate} _ ---------- Date Issued ---- -- -- This Permit Expires 1 Year From 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- TRACT "` ' / D". �" /r, _h --CENSUS JOB ADDRESS TRACT Phone -------------------------- --------- Owner's Nameyb"1�- # ----------------------- Ci �t1a-✓!- -------------------------------------••- Add - �- ress - a- a/ �. �----•----------- - ----. city Contractor's Name U�/ G✓huh"--- ----;- ;° ------License # ---- ----------- ------- Phone ------------------------------ Installation will serve: Residence ❑ Apart%ment House❑ Commercial :[:]Trailer Court ,E] I Motel ❑Other -------------------------- --------- ------ 1 - Number of living units ------ Number of bedrooms ----.--Garbage Grinder ------------ I _--__.-_-._ Lot Size __ . __F-GAS_._______"- t �7-�� / Private -------------------------------------------------- Water Supply: Public System and name ------------------------�-�- ----------------------" i Character of soil to a depth of 3 feet: Sand'❑ Silt El ❑ Peat,❑ Sandy Loam ❑ Clay Loam El IHardpan ❑ Adobes]'- Fill Material ------------ If yes, type ---------------------------- I " i )Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be .placed on reverse side.) ` p seepage pit permitted if public sewer is av ilable within 200 feet,) NEW INSTALLATION: (No septic tank or <�/ SEPTIC TANKIType Size--- ---- Liquid Depth ------,- PACKAGE TREATMENT [ � """ """ �-""" -"-" ' �� Material__ U.,_.__ No. Compartments __ --y•••-=---- Capacity ------ Q ��` Foundatio ---0-*----- ��op. Line -V�__.--------- Distance�to nearest: Well ----�---- ----------------- �..77 LEACHING.LINE No. of Lines,.—T------------------- Length of each line____- ---------- Total 'Length -T•- --- 'D' Box r -"" Type Filter Material f�1�-______Depth' Filter Material -------- ---------- X, ��---��---//-__----------- Foundation /V-71(-' Property Line -- ------------- r Dis#ance�fio nearest: Welk�.r�T ---- -""- SEEPAGE PIT [ ] Depth ------ Diameter ---------------- Number ------------- ------ Rock Filled Yes ❑ NoID ` Water Table Depth ------------ _Rock Size-V ------------- -------------------- I Foundation - - Prop.,Line ---------------------- Distance to nearest: Well _-------------------------------- - �} --------- ----- Date -------------------=--------------}. REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------ I I Septic Tank (Specify Requirements) ------------------- - -------------------- -----"Disposal Field (Specify Requirements) _____________ ------------- r -----------f --- =------------------------- - -------------------------- ------------------------------------------------ --------------------------------------------------------------------------------------------- (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 Lows,!and Rules and Regulations of the San Joaquin Local Health District. Nome owner or licen- sed agents signature certifies the following: r "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 suWect to Wo�n's Compensation laws of California." Signed ---- 2� - 1 == = Owner -- BY -------------- ------ ----- - --------------- Title ------' ---------------- (If other than ownC r) t F R TMENT USE ONLY rr'' APPLICATION ACCEPTED BY ------ ---------------------- ------------------- DATE -------hi f BUILDING PERMIT ISSUED ____--- -- - -- -- -------------- -------------------- ----"-- -----=--------------DAT ---- ------------------ ------ ADDITIONAL COMMENTS ------- - --- - --- ------------------------ ----------------------------------------------------------------- __ - -------- -------- Final Inspection b Date -�`-- �------------ SAN JOAQUIN LOCAL HEALTH DISTRICT C� E. H. 9 1-'68 Rev. 5M _