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FOR OFFICE USE: �_(&_�v f � a - APPLICATION FOR SANITATION PERMit L Pern`it No, b- (Complete in Triplicate) F This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local"Heait.h 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/LOCATION . T_�1f .__ 7_d ty_ ___L° �� CENSUS TRACT --------------------_-___ i Owner's Name 'V",; �`t- �i�,�.. t ---------------------------------------Phone ------------------------------------ Address ------�e2_11*7 --z-------------- ---------- -- City '-f. r --------- Contractor's Name -_-1eP7P7.- --------------------------------------License ,t�_.'�� --- Phone 1� .17!t_Z1K t Installation will serve: Residence$Apartment House-E] Commercial ❑Trailer Court ',❑ Motel ❑Other -------------------------------------------- Number of living units-----1----- Number of bedrooms .____Garbage Grinder /�--- Lot Size �_ - .r" ___________________ -C��(5_ Water Supply: Public System and name __ --'(�410;4__ ________________________________Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material If yes, type -_____._________________ (Plot plan,"-showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) V IIr NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 4E PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -------------------- Capacity.....---------- Type ----------- '------- Material---------------------- No. Compartments ------ -•-•----- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line .-----••---.._......-- LEACHING LINE [ ] No. 'of Lines _____________ Length of each line---------------------_------ Total Length --------------------------- 4 A 'D' Boz ---- ------- Type Filter Material --------------------Depth Filter Material ----------------------------_...-----...'---. '. Distance to nearest: Well --------- -----------___ Foundation ------------------------ Property Line ----------------------- SEEPAGE ___________-__- -_-__-SEEPAGE PIT [ ] 'Depth$'__`- ----------- Diameter ________________ Number ---------------------------- Rock Filled` Yes ❑ No C] Water Table.depth ------------------------------------------------Rock Size -------------------------------- Distance --------------------- --------Distance to nearest:Well ____________________________________---Foundation --------__--__-_--__ Prop. Line .....__.__........_... „ s -REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------- ) ----------------__gDaate ---------------------------------- Septic Tank (Specify Requirements) ------- -1 .-eAP-- //4;"l�l----/ 9 ------ ------------------------------ 4 Disposal field (SpecifyxRequirements) ----- l ' B --------------------------------:- ---- -----------------------------------------------------------=-------------------------------------------------------------------------------- -------------------- (Draw existing and required addition on reverse side) r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquiny 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 in the performance of the work for which this permit is issued, I shall not employ any person in such manner Y as to become subject to Workman's Compensation laws of California." Signed -------------- -.- ---------- -------- ----------- - - -------------- Owner BY -- Title ..f -------------------- --- -- (If of han owner] OR .DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY - -- ----- ------- ------------ --------------------------------------- --------------- DATE --- ---.----- ---7,e................ ;f -BUILDING PERMIT ISSUED -------- ------- ------.---- s-- - s� --DATE --------------------- --v------- ,tee' ADDGIRTIONAL COMMENTS OMMENTS--------_------ro-S- � .. --------- - --- -` - ---s�-`---- - - -l-7--- - .. r ----------- --- ---------- --- � I Final Inspection by: , --- -- C - - ------------------------------------------ ate --- - 4.0._-_ --^- .. ------ � � /TCQ SAN JOAQUIN LOCAL HEALTH DISTRICT ��✓ E. H. 9 3-'68 Rev. 5M. - !