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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i --. ........., Permit No. ... '1?-- (Complete in Triplicate) �� 77 ......................................................... This Permit Expires 1 Year Front Date Issued Date Issued . ..............- L8-D—U f 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. 544 and existin R fes and Regulations.jd` 33" r`76L J BeADDRESS/LOCATION °-Q-. ..W J E �fr 4!,4 5....... 5/ -n-�......--- E SUS TRACT .......................... Owner's Name ..... !!�iv .....' "J_....._ v_ /.................... . ........ ..---- Phone . . . _....... .. I Address ...fL�.. •%v IAZ4/W .... City �l,4"w . Phone Contractor's Name ...��i.�'��Cr...�..-'---....- --- -'--•-'-- •---•-----•-----..._.License Phone Installation Will serve: Residence-'5�-Apartment-House-,❑-Commercial-❑Trailer-Court❑-- 1 Motel ❑ Other ......_--------------------------------- Number -------------------------------Number of Irving units:............ Number of bedrooms ......Garbage Grinder Lot Size ......__.....______...__......... ......... Water Supply: Public System and Warne •------ -------- --------------------_------------------ ...................Private Character of soil to a depth of 3 feet: Sand , Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ , � i Hardpan ❑ Adobe ❑ 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,) r; PACKAGE TREATMENT - SizeSEPTIC TANK' Liquid DepPh,.. W � � ------------------------- . ..--._ -- . Capacity ...... Type -------------------- Material--- ....._'- ......... No. Compartments ........_--••--- -_..6. i Distance to nearest: Well ... ................................Foundation .... Prop. Line ................. 0 LEACHING LINE [ ] No. of Lines Length of each line............ ... ....... Total Length' ..._•--------•.-------••--_. {.1 y •D' Box Type Filter Material ..............'.-.. Depth Filter Material ..................................... Distance to nearest: Well Foundation ...................... Property line ......................... SEEPAGE PIT ( j Depth ... . .. Diameter ................ Numb .t_----..._--- Rock Filled; Yes ❑ No ❑ I �- Water Table Depth .......-'--- ' _...__.. _Rock Size --.-- Distance to,nearest: Well --------------------------------`_. _-Eoundafion =! ---'- ....... Pro line .................- w :.:� —r ... p. ..... , REPAIR/,ADDITION(Prev. Sanitation Permit# --------- ............... ................*Date _.. ............................. ) Septic Tank (Specify Requirements) '---'-' ---"-'---'-_........._.................'• -• ............. .................... Disposal Field (Specify Requirements) ..... '.._. '... ..........' _ e . }... ...................' --.... --•'--. ---.... . ....... t .a � '(Draw existing and required addition"' reverse side) {' a I hereby certify that I have prepared this application and that the o li will-'be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaq'u n local Heplth-Dis'trict. Home owner or [icon. , sed regents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ an 'person in such manner asto i become subject to or n's ompensation laws of California." ' as to =. . 3 '_. . . .;.. _. .e.... - '---- OwnerSigne , k BY .... '- " Title > r. '._.. ..'.:. ........+.Y. .......... Ilf other than owner) F >rPAiRTMENT, USE ONLY� APPLICATION ACCEPTED BY _....._ �U ................ DATE .......:3 ' ............... BUILDING PERMIT ISSUED .-..:; ' ' • DATE ADDITIONAL COMMENTS .. - " " ..,�.-- ---..................'-•----. .•....-'-•---' -------- ------------------------- •' --- ....... .......... . :., -•--•..........................'.....----.....----- Final Inspection by ..... • ................ .......... ...... :...Date ._. `- O- L�'�...... SAN JOAQUIN LOCAL HEALTH DISTRICT 0 E. H. 3 24 1.'68 Rev. 5M 1 7172 3 M