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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . 4 Permit --------------- -----------• - ------------ (Complete in Triplicate) i -------------------------------------------------------- ' Date Issued '`?`. a9�9 This Permit Expires 1 Year From Date Issued i 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- ------------------- egulations: JOB ADDRESS/LOCATION -f = E / _fr -'>---------------CENSUS TRACT ---------------- -------- Owner's Name -------------------- -- ---------- 'Phone - -------- ----- - ---------- -- --- - -- Address ------------------- - - City = ------ LC/ �e0'�'�✓ --------------License#------------------------- Phone"T -� �� Contractor's Name _.- --------- ------------------------ -'---- ------------ -- Installation will serve: Residence ❑ Apartment House❑ Commercial:❑Trailer Court Motel ❑Other -------------------------------------------- : Number of living units:__1.... Number of bedrooms ____Garbage Grinder ------------ Lot Size ----- ---------------- Water Supply: Public System and name ------------------------ ---- -------------------------I--------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay .❑ Peat El Sandy Loam Clay.Loam Hardpan ❑ Adobe.0 Fill Materiaf'o1---_ ___ If yes,type ._____-_.___-.-_______--___ f (Plot plan, showing size of lot, location of system in relation to wells, buil`dingss etc. must be placed on reverse,,,side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewe is�available within 200 feet,) ~ PACKAGE TREATMENT [ ] SEP 4C TANK fi] Size___,1e------------- ----------- --------- Liquid Depth --------------------,-•-- € .��. +`Capacity Type Material. No. Compartments = r Distance to nearest:-Well -----------------}----�-------- .Foundation ----------------------.Prop. Line -----------•---------- ¢" LEACHING LINE [ ] No. of Line fS"�` ---------- Length ofVeach line---------------------------- Total Length =1-11 j 'D' Box ------------ Type Filter Materia!'_--,- ----,-Depth Filter Materia! -------------------------------------------- "� ,_ _ ;. ------ Distance to'�nearest:'Well _---- --, F?-U. to On ---=-------------------- Property Line ------------•-----_----- 11 SEEPAGE PIT [ ] Depth --------------en D�arnefier ________________ Number Rock Filled Yes `❑ No i❑ S Water Table Depth ------------------------------ ----'-=---•----Rock Size -------------------------------- Z Distance ------------------------ - Distance to nearest: Well --------------------- --------------Foundation ------------- -•--.. Prop. Line ---------------------- REPA1RfADDITION(Prev. Sanitation Pet �# -------�------------g-=� ---------------- Date h Septic Tank (Specify qu�irements) - - ► _ ,.t'i'.. f --------- --------- Disposal-Field (Specify Requirements) ------- , --- ------- ---------- -- ------------- ------ -- -- -------------- - - .� YikV ___________________________________�____- -' v --------------- .� 1. :�_.`- I= = ---- ---- -- a •- - + (Draw existing and required addition on reverse side) f1hereby,certify that I have prepared this application and that the work will be done in accordance with San Joaquin ...i: County-Ordinances, State Laws, and Rules and Regulations gulations of the San Joaquin Local Health District. Home owner or licen- sed'agents signature certifies the following: xNjl "I cerfffy that in the performance ofAhe,1work for,which this permit is issued, I shall not employ any persan, in such manner r as to become subject to Workman's Compensation laws of California." ' -------------- Owner Signed ----------------- --------- N Y rh,--r Jitle r--- - [Iowner} FOR .DEPARTMENT USE ONLY ' . # APPLICATION ACCEPTED BY ---------------------------------- � ��------------------ - ---- �L�Q-/� DATE BUILDING PERMIT ISSUED - ------------------------------------ v DATE ADDITIONALCOMMENTS ---------- -------------------------------------------------------------------------------------- -------------------------------- --------------- - -------------------------------------------------------------------------------------------- - _-_ t _ w w - "------ ---- - - ---------- Final'Inspection bY: ------------------ -- Date s --- - - --- -- SAN JOAQUI CAL HE H TRICT i 1 F E. H. 9 1-'68 Rev. 5M.