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s FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � �----- ----------- - _ Permit No: -��-=S�l 3•---� {Complete in Trip icate -----=-'-------------------- ----- 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: JOB ADDRESS/LOCA ION -1 --CENSUS TRACT __________________________ ��=/__ -.xg.,! ----------__ ---------------------- -------Phone ----------------------------••------ Owner's Nam Address ----------------- city c `-' ------------------------------•----••-/••-- el Contractor's Name -_ -lei~%___--1�c ------' --------------------------------------license # -`l if --- Phone _'%11krr l� _ _.._ Installation will serve: Residence partment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other ---- --------------------------------------- Number of living units:__________I Number of bedrooms ____ ------Garbo a Grinder f Lot Size xp---- ......... WaterSupply: Public System and name ----------------------------------------------------------------------------------------------------------------------------------------------------------------•----- Private I Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ } # Hardpan ❑ Adobe'51-,-FI?1 Material elle'_--- 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 seepage pit permitted if public sewer is available within 200 feet,) t PACKAGE TREATMENT ( ] SEPTIC TANK'] lize____-Xx X --------- ------------- Liquid Depth _ --------------- Capacity Type _ si - Materials No. Compartments _ ---------••--- **N [ 4 f fi }-----------•------ k Distance to nearest: Well _____ �--- ---------------------Foundation - --------------.Prop• Line r .r/ LEACHING LINE No. of Lines ___ ______ Length of eac line___ .S__�`&- -------- Total Length ---•-----•• <r i � ` D' Box _ _ Type Filter Material fl ______________Depth Filter Material _//___________._..____-._--....._--••- `\7 Y_____-- Foundation --- d- Property Line ____S___r_ ___.- Distance to nearest: Well __ -•-- __ _____ - --------- - __ Rock Filled Yes p---_N0 SEEPAGE PIT ��bepth —__�a ._'__ ___ Diameter �.��' ---- Number ._r - ------------- -- Water Table i Depth ----- f ---f-----------------Rock Size ------------ Distance to nearest: Well _______ J ______ -------.Foundation ---/! F------ Prop• Line ---,5-- ---- -------- REPAIR/ADDITION - (Prev.(Prey. Sanitation Permit# -------------------------------------------- Date ________--------------------------} t Septic Tank (Specify Requirements) ---- ---------------------- -----•---------------------------------------------I- Disposal Field (Specify Requirements). ----------------- ------------------ --------------------------------------- ;t --------------------------------------- ------ .. ------ --- ---------------------------------------------- - ------------------------------------------------ :------------------------- ------------------------------------------------------------ (Draw existing and•required-addition_on_reversesidp) I hereby certify that I have prepared this application and that the work will be.done in accordance with Sart Job+ glin 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;1 shall not,employ any person in such manner as to become subject to Workman's Compensation laws of California." - + Signed ------ -------------' --------- - - i--- --�-----------•----------•---:Owner w � r��. ,/] _ _`��T----------------- Title = - ------ - ------------------------- BY ------------ ,_. (If other t a� nerl .FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---f`' -----------/Vt-- -8--�¢---------- ----------------= ;. DAZE _ .--r�_- ----- "_ 7 BUILDING PERMIT ISSUED ----- -- -------------------------- -------------------- -------= DATE ADDITIONAL COMM TS __-- ;- - -- ------------------------ +71--- -------- �9--�---- --- --- ✓`. --- -- ----------------- ---------------`---------------------------------- . 11 ,-/�--.�- )__-.-___ --- - ------- ----- --------------------------- ]4- - Final Inspection b Date _ - --- --- -- - a SAN OAQUIN LOCAL HE4TH DISTRICT '�E. H. 9 1-'68 Rev.