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FSR OFFICE USE: �- FJ,O U APPLICATION FOR SANITATION PERMIT --• ---------=------------- Permit No-.60 /L'.70 - (Complete in Triplicate) ------------ ---------------------------- --------------- -------------------------- ThilrPermit Expires 1 Year From Date Issued 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 ules . t sqq - and �ula TRACT -------JOB ADDRESS/LOCATIO -------- Owner's Name v7 e ------------------------------•- t f N �� Q Address -------------- - --�---�---- �- . �-�---- - ----�_��-�-�-- - -------------------------- City -�-- -��-Ce� -- -- � ........ Contractor's Name _ �- � � License # `� � �f Phon at' _ 7� G--- �` - - - --- - --- e� Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court Motel ❑Other - W 17-C_f Number of living units:------------ Number of bedrooms ----------.-Garb�a�gee—Grinder ------------ Lot Size ____________________________________________ Water Supply: Public System and name ---------- i, _ OJd7LA.�T---------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'D?( 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ) SEPTIC TANK Size----- _-40PXXLiquid Depth _`'------------- ,c— Capacity/,74! f7 _ _, TypWaA-Y-- Material _ 2�kI_��_%_ No. Compartments Distance to nearest: Well ---------Foundation �__:______ Prop. Line .16�2_-:-...--._ LEACHING LINE [ j No. of Lines - -- -------------- Length of each I' e---��_I?---__-_____ _ g Total Length -- --�J----------------- D' Box _- Type Filter rMate Depth Filter bAciterial _____-.-________ ________ R Distance to nearest: Well __ < ___ Foundation ------ Property Line -1e�:__-.__-_- SEEPAGE PIT [ ) Depth --_ �7�-____ Diameter _ ___-_-- Number C -__I _ Rock Filled Yes No G Water Table Depth -- 60----------------------------------Rock Size X7 Distance to nearest: Well -------------------Foundation Prop. Line REPAIR/ADDITION(Prey. Sanitation Permit# ____________________________________________ Date ---------------------------------- .Septic ____________.________.__________.Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------------------------z----------------- ----------- . Disposal Field (Specify Requirements) -------------------------------------------------- - - --------------------------------------------------------------------------------- 4 ------------------------------------------------- --------------------- _ (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 Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that i the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become bjec to -or kman's Can ensation laws of California." Signe 0/113 C c _ ------ _ _ „ ----- ----------�--------- Owner -n� By �- lc:�. - ---- ' Title . (If other than owner) EPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- / ---- --- ---------- ------------------------------------------------ DATE --- 1-.2,(7-69- - ---------- BUILDING PERMIT ISSUED ----------- - ----------- --------------------------------- --------------DATE ---------- ------ --------------- AITIONAL COMMENTS ----------- , --- - --- ---- ---------------- ---------------:--------- --------=--------------------------- ---- - 47----- -------- ---- --- --- ------- ---- W-a-4--- .------ . �� --- ------ g— - -- -------- ............ F d-'Z •c A t G3. iii e-c�. ----------------------------- - ------ -- - ---------------------- --------------------------- ---------------Date ---- -----------/----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M--