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•--`1-"'FOR-OFFICE USE: `APPLICATION FOR SANITATION PERMIT -------------------------------------------------------- - 7� Ih: (Complete in Triplicate) Permit No, _____________ ___ ----------I---------------------------------------------- Date Issued 70 -._.-_____.________._-______________________-A---- This Permit Expires i Year From Date Issued ��-.a3r :r Ij 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/'LOCATIONIl.---- -O--�/� S. �_�1�� V � CENSUS TRACT -------------- -----•----- � � r Owner's Name .__ I ----------------- -- -� -��-�-�-`---��--- - ----:--•----•--•-------= �--'------------- --- - - ------Phone /9j-2 r__77=-�-- Address �r i I , cr .City .� �!_�/ d_ � .. �._.. ........... Co�tractor'.s Name ------- Y ti' Waif lC-f,'e'_l�--------------------------•----_ .License # ------------------------ Phone -------------------- - Installation will serve: Residence IV Apartment House-E] Commercial ❑Trailer Court ❑ ; Motel ❑ Other -------------------------------------------- _..� Number of living units:---______ Number of bedrooms _______Garbage Grinder ----0`.___ Lot Size -1_ss___-___ __ __ Water Supply: Public Syste6 and name ----------------------•---------------------------------------------------------------------------------------Private Character of soil to a depthlof 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -K Clay Loam ;❑. ' Hardpan 0 Adobe ❑ Fill Material _=_-_.______ If yes, type ' �f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 0 i' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ];� SEPTIC TANK.( ] Size------------------------------------------------ Liquid Depth --e--�---�-- ------ ----------- pa�eto - Type ------------- Material ------- No. Compartments ------ - her istaneares#: Well ------------------------------------Foundation -.--------_----- Prop. Line .--•-----------,_--_--L � EACHING LINENo. of Lines ___5_________________ Length of each line-------7-0------------- Total Length ,____ C_Q_____.______.. D"IBox __) ______ Type Filter Materia �ou __De th Filter Material cam» Distance to nearest: Well _ _Q___U_ - ation Q `-------- Property Line _-____-.. SEEPAGE PIT [ ] Depth ----- ------------- - Diameter ---------------- Number -- ------------------------- Rock Filled Yes I[] No 0- Walter Table Depth ------------------------------------------------Rock Size ----------------------- . -------------------------------- II f ° Distance to nearest: Well ________________________________________Foundation __----___--_______-- Prop. line _______________...._-- REPAIR/ADDITION(Prev. Sail nitation Permit S# -------------------------------------------- Date ----------------------------------1 � Septic Tank (Specify Req�U irements) Disposal Field (Specify "Requirements) -------------------=----------------------------------=---=------------------------------------- '. 1 - ------------------------------------------------------------------------------------------------------------------ --- --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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: "1 certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to become s�,, c' W it kman's Compensation laws of California." Signed ------ . .. - ................................... Owner ------------- Title - --- --------- (If other than Towner) :I F R DEPARTMENT U E ONLY APPLICATION ACCEPTED BY --- - - ----- -- -- -----------------------------------------. DATE BUILDING PERMIT ISSUED '------------------------------------------ -------------- TE ----- ADD( IONAL OMMENTS ----- -- - - -- -------- --- ----- - ,�✓_ A" :: __ ,�--- ------ c� �UlST Fin Inspection b = Date -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M