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FOR,OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------w- ----------------------------------- Izq o7 F" (Complete in Triplicate) Permit o. Date Issued ------.----- tir`a This Permit Expires 1 Year From bate Issued aAppi ' ' fttrr� Es hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein detscribed. is 44lication is made in compliance with Co my Ordinance No. 449 and existing Rules and Regulations: r. JOB-' ESS/LOCATION �--------------CENSUS TRACT ----------- -- C�wnera Name{_ . + 1� - �------------ -------- ----- ------Phone ----------- - -------------•----- I_ ! -1------------ ��-'��F------------ -- ------------ --- ------- City ---- ��0_C` 44�------------------------••---------- 66tractor s. fame _ "_�0._� -fi_-�l-Y: - ------S-2_p_r)-C----!_m`�(1X'_"-.License # - r 1-- Phone _ ---- �:•�- Install9t1on�will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court " ❑Other -------------------------------------------- Motelfill y6. �� .P;g,. �` ,� ttilU..4. of,'living units_____________ Number of bedrooms _______"____Garbage Grinder ----_.______ Lot Size __-_-- -- -- •�--------- P Ta of ply: Public System and Warne -- __ /?'1fW 11�I-1' --- ��--1 � - Private SNatbr 4Sv p Ch ', of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat❑ Sandy Loam { Clay Loam 0 Hardpan ❑ ❑ Fill Material -- _ "___-- If yes,type ---------------------------- Adobe ` -(Plot i9i`an, showing size of lot location of syste in relation to wells, buildings, etc. must be placed on reverse side.) A NEVYrINSTALLATION: (No septic tank or seepag pit permitted if public .sewer is available within 200 feet,) i } t .;�PACWAGE TREATMENT [ SPTIC TANK [ } Size---------- - --------- -------------- --- -- L' id Depth ----.------------.•. ----- 'SE ��y ph" CapacftY TY e Material No. Compartments Dust stice to nearest: We I'F apa'city ___________________-- Prop. Line ----------------- _ .. s s. . i r'. ACHING LINE Na .; f l Ines _______ _:_"__ Length of each line-___- 167-111,------- Total Length ---- ._______ __.. - it D' 13ox - - ---- Type FiI er Material Depth Filter Material ------ ----------------r-�- -•- "�r Distance to nearest: We I _""/ � Foundation ------- SEEPAGE -IT pe Property Line---------------- --------- --- Property --- 4 [ ] 6epth -------------------- Di meter --_------------- Number .-_- -----------_- Rock Filled Yes ❑ No Water Table Depth ------ -----------------------------------------Rock Size -------------------------------- Distance ----------------------Distance to nearest: Wei --------------------- Foundation ______.______-""--- Prop. Line ---------------- __-- --) "'. . REPAI ADDITION Prev. Sanitation Permit=# __-•- ------------------------------------- Date ------------------------___-_- - ;r , Septic Tank (Specify Requirements) ----------------------------------------- --------- -------------/ Disposal Field (Specify Requirements) --------- ------- -&- —-" G7� ��----- - 21. 1 -;--�- -- ---- -----------��l�'' _ - .� -- .. =---------------- ----- ----------------------- ------- ------ ---- -- -- - -----------------------------------.------------------------------------------ ------------------------ ,.'ss (Draw existing and required addition on reverse side) " 'i fiere certify'that I have prepared this application and that the work will be done in accordance with San Joaquin Q 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: 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 subject to Workman's Compensation laws of California." "Si ----- ----- ------------------ - -------------------------------------------- Owner . `w y ---------------------- BY ----- ------ Tit e ------ ' (If other than owner) " V FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ` f _ 4 ----------------------------------------- -------------------------------- DATE ---7--7! f " -- BUILDING PERMIT ISSUED ----- ____ ----- --- -- - -----------------------•---------- - -------------DATE ------- --- --------• _."__. r ---- ------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- --------------------`---------------_^_--------- ----------- ------------------------------------------------------ -----_------------------------------------------------_---------------- ---------------------------------- -- ------------------ _----------- Final Inspection b - --e---%- �---------------- ----------------- 7_-__3--`� 7 ------ - - _Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M