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FOR OFFICE USE: 'APPLICATION FOR SANITATION PERMIT I Permit No. .________ - ---- -- - - -- E . (Complete in Triplicate) -------------- --------- ----------- � q Date lssuedp:�l=, �-- This Permit Expires l 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: - ..,. JOB ADDRESSjLOCA710N .�. --t - - �� Vf��----1 � 0____. CENSUS TRACT --------------•--------•- Name .-/--4 _ 1� �1-------- Phone Owner's ---- Address "/-Q6 ' + i ' wl ` L ��Y --------- City ! '/a � r Contractor's Name 14; ,V/1V-J",'- - /� � .License .- �Q P.hone,3 .Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ,❑ - Motel ❑ Other .____�Ljd-� rte-----OVA1;, W, �s Num �� .>��y�f � �j - ber of living units:---_�__.__ Number of bedrooms �--____Garbage Grinder- Lot Size ---------- Water Supply: Public System and name ------ -----_-------------------------------------------------- ------------------------------------------------Private [ � s Character of soil to a depth of 3 feet: Sand'[ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ r , 11, • WI ; Hardpan ❑ Adobe ❑ Fill Material _ ---------- If yes.type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] NEW INSTALLATION: (No septic tank or.seep a pit permitted if public,sewer�is available within 200 feet,) SEPTIC TANK ------------------------------------------t ' - q p -------- PACKAGE ------PACKAGE TREATMENT [ ] [ Size - o. Com artmen ----------------- Capacity/t4_&0,0 Li ui Depth ------- Ty'AA y,44 .�114aterial A ON Compartments . r --- � - s Distance to nearest: Well -r--- ------------------- =Found ation°_f0--------------- Prop. Line ___.-----------_----- ------------------ LINE [ No. of Lines ___ --------------- Length of each line--- ------ - Tofial Length -! D' Box + -s-,_ Type Filter-Material O_ .:-:Depth-Filter--Material �_ _____--------•---.-------:---_-------- Foundation _.______ ___ Pro er Line. ---------_______________ Distance to nearest: Well ___________________ _ p SEEPAGE PIT [ ]' Depth Diameter ________________ Number __________-__ Rock Filled Yes El , No i a Rock Size-_ ------------ Water Table Depth -------'-- -- - 1 { K ------------- r, ------Foundation -------------------- Prop. Line -------- ----------• - [ Distance to nearest: Well _______________- REPAIR/ADDITION(Prev. Sanitation Permit# ------------- ---------- Date --------------------.-------------1 i Septic Tank (Specify Requirements) ----------------- �-------------------------------}----•------ : --------------- w�. -. --- ----------------------------- Disposal_Field.,(Specify Requirements] --------------- -------------- ------' ` '-`------------------ ti ---------- ------- . ---------------------------------------------------- -------------=--------------------- lR _ _ ___________________-____--__________---___________--________.___--_______ _ ___ -___________--__________-._._____ _ __ _ _ ___ _ ------------------------------------------------ _ 1 (Draw existing_ __ __ an_ _ __d 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: person in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any as to become subject to Workman's Compensation laws of California." e Signed ----=- ---------------------------------------------------------- Owner - ------- - - E� ----------------------- By ---- 7itl � �� '� (If other t fnow �� 7 ,�g FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By ------------ - - - - t- - --��--------- ---- ------- ------------ - -------• DATE --- f r ' '? _----------- BUILDING PERMIT ISSUED -----------`------------------------------------------- --------- ---------------DATE -------- ---------------------------------- - ADDITIONALCOMMENTS ------------ ------------------------- ------------------------- -- ----------------------------------------------------------- ------------------------------ ------------------------ - - ----------------- ----------------------- ------------------ ------------- ' --�- ------------ -------------------- Dat - --- - -------- ------ -------------- ---- - -- ------ `-!.� _ Final Inspection by SAN JOAQUIN LOCAL HEALTH DISTRICT 'C F. H. 9 1-'68 Rev. 5M