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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: ____ ---___ -------- ------------------------------------- f ' _________________________________ This Permit Expires 1 Year From Date Issued Date Issued __ _ --67 Application is hereby made to the San Joaquin Local Health District for pr� q permit to construct an install the work herein described._This,application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: (n(.3$� nJ.-ff�FrFecJ_ 4 j.f 6 �Ef2 �r - JOB ADDRESS/LOCATION . .N./- -------- - -------/*�-Z-------W-0-r,-,�_ 1�-l� € _CENSUS TRACT --•---____-- --- -- _ •-- { Owner's Name -- -? f 7 -� +�c�f�� ___3----------------- --------------------------------- -------------------Phone /. 73T Address --. V? -------------------------------------`----------- City1?0_AJ Contractor's Name _- L -r. ------- --,c -jam-9_x_1-`-------------- ------.License # _ _ 'l Phone --- "` .- _._ - Installation will serve: Residence ]Apartment House❑ Commercial:❑Trailer Court Motel Other -__- Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ______-______--_-_._______ ------------- Water Supply: Public System and name ___________________--._ _ _ - - ------------------------------------------------------------------ Private to Character of soilfio a depth of 3 feet,_ `Sar d_'0-_SiIf❑ Clay-E]--Peat. ❑ SanZly`Lou m-E1 Cldy-Loom ❑:' -,171 Hardpan ❑ Adobe 'Q Fill Material ------------ If yes, type ---------------------------- (Plot _____________________ _____(Plot plan, showing size of lot, location of system in relation to wells buildings, 1 Y d ngs, etc. must be placed on reverse side.) � NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK Size-------- P, Liquid Depth ------Vi --- :• -- Capacity _9_ - ______ Type f�. fMaterial__�-$-ryNo. Compartments _______________ Distance to nearest: Well ------- -_-_ P -�- --------Foundation ---�--�-- - - ------Prop. Line ---'�-----.:.-•----- ' LEACHING LINE { ] No, of Lines ------ Length of each line-------- --------- Total Length :_-- �__...__-- --- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -----------------------------------------_- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ SEEPAGE __-___---- __ _SEEPAGE PIT [ 1 Depth -------------------- Diameter ---------------- Number------------------------ --- Rock Filled Yes ❑ No i❑ Water Table Depth -------------------------------------- -------- Rock Size Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -.---------._._..---_ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date .___________-.____ t Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- I Disposal Field (Specify Requirements) _____________________________________ , ----------- - ---- ---- - a --------------------------------------------------------- ------- ----------- , - ----------------------------------------------------- ---------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed �_ _ - --------- --� ------ Owner ------------------ ---- - - - - - ----- ------ - ---- ---- -- BY --------- ----- ---> .._ ----�--- ------ -------- --------------- --- Title - ---------- - (If other than owner] FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE _� � A ------------------ UILDING PERMIT ISSUED ---------DATE ------------- ---------- ADDITIONAL COMME=NTS -------------------------- -- t -------------- --------------------------------------------------------------------------------------------------------------------------------- -- - -------------------------------------------------- ------ r --- ---------------------------------- ---------------------------------- -- -------- -44 -- -----------------------------------------------------------------------pate _ N Final inspection by: � _ a -- ------- r.. . SAN JOAQUIN LOCAL HEALTH DISTRICT R E. H. 9 1-'68 Rev. SM.