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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. Qom'^ ------,--- (Complete in Triplicate) --------- Date Issued �_�_�7 �7 ----- --------------------------------- - f+ This Permit Expires�L,Year From Date'Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made.in compliance with County Ordinance No. 549 and existing Rules and Regulations: I ,/ g f � {' JOB ADDRESS/LOCA N _- -y_4Sr_1�L�J ��_*=_ ✓©''�---- ---------- CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCADPN --- ------- Y +4 - -----------•----------- r# Owner s Name .� :-------------- -------- -Phone. E. 9 ----- ------ AddCity = ress - - k dji a Contractor's Name --------see-/Y ---------------------------------------- --------------------License #= = Phone o Installation will serve: Residence []Apartment House❑-Commercial ❑Trailer'Court ',❑[ Motel [}Other ----- -"--l --f'P.�vltcuyn { 4s� Number of living units:__________ Number of bedrooms ----_--------Garbage Gfinder,�______-- Lot Size ----ir-<- - -fv-_------------_----- Wat Ir Supply: Public System and name ---------------------- ----------L.-----------------------2 rr-----Private M� ....�.. .4. ._.- .._.. r , Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay .❑ Peat❑ Sandy Loam,,[] ay Loam ;❑ Hardpan ❑ Adobe; Fill Material ----- ------ If yes, type ------- __________________ + (Plot`plan, showing size of lot, location of system in relation to wells, buildings„Fete. must`be placed on reverse side.) IE NEW.INSTALLATION: (No septic tank or seepag pit permitted if public.sewer s,available within 200 feet,) , PACKAGE TREATMENT [ SEPTIC TANK[ Size-f-5,1( :_;!�-�`-- / ____ Liquid Depth ___ Y_e _______________ _.C2 Capacity DU--„ Typea_ /5►< o_`�e Mafie/al No. Compartments istance to nearest: Well _--7-- s -----_Foundation __ _________________ Prop, Line ___�.__________...__ LEACHING LINE [ No. of Lines _____/_________________ Length'`of each line_---.�0/---------- Total Length_ ____-..eG__-_----.-__ i 'D' Box X11____. Type Filter Material k;P0 __Depth Filter Material ____/V_ ___________________________ Distance to nearest: Well f......... Foundation ------------- Property Line_ __!-.............:.... SEEPAGE PIT [ ] Depth ____________________ Diameter -----------I--- Number --------- ------------------ Rock Filled Yes ❑ No WaterTable Depth ------------------------------------------------Rock Size ----------------------•--------- I , Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------- --_-__-- I F � REPAIR./ADDITION[Prev. Sanitation Permit# ________.------------- --------------------- Date ________._. _____....----_-_-- - Septic Tank (Specify Requirements) ------- -(1(L.atr kw�-'-"'�---•_={�---.��-� ---- • - ---- - - - ----------I----•--• ¢� Disposal Field (Specify Requirements) --------------------------- ---------------------------------------------------------------------------------.------------ ;-------- ---------------------------------------------------- .;. ---------------------------------------------------------------------------------------------------------------------------------------------- ---- --------=----- ----------------------------------------------------- ------------------ ------------------------------------------------------------------------------------------------------ (Draw :---------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) i 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. Horne owner or licen- sed agents signature certifies the following: `� I "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 ct to orkman's-Co sation laws of California." F s ------------------------ Owner \ I .. . ----- -Title --- - ---------------------------------------------------------'--- BY '------ 7�r - ------------------- r (If other than owner)- I FOR DEPARTMENT-USE ONLY I APPLICATION�ACCEPTED -- - --------------------- DAZE --- a - ._ ` �_-`--••--- __ BUILDING PERMIT ISSUED + --------------------------DATE - -- A DITiONAL COMMENTS _�'.7 i � _ a ��'f ---- r�r------'-- - s-op--<� ----- e}1�-.--------•--- r� fs� � } ---------- . �j (_ -- --------- ----------------------------------------- G -- --- - ----- ffl'� — �01 ---------------------------------------- - -- ------- - - ------ ---------- --------------------- r # Final Inspection by: --------------------------.Date -- I 7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 "••..1,'68 Rev. 5M