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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT q � Permit No. --�1---`-r----- -------- '-- `-------- � (Complete in Triplicate) / Date Issued --/O--a- --7 This Permit Expires 1 Year From Dale Issued ----------- , 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: t �/ / �j} --- -------CENSUS TRACT ------JOB ADDRESS/LOCATION ._ ,�[--(c� --- � ��A�I�---llf -------------------- 75 Owner's Name ----�p--G--- - - ------------------- ------------------------ Phone . 11 73Z jy �7�_� N----------------------------------------- 0"VPAddress -- ._�_. zY/�� _�/�fC1 �----------------- Contractor's --------------- City . License #Q?A2.—F1'- Phone -4/ Contractor shame ---- - - �/--�� _(t AlM-�1-I1+' ----------------------------------- Installation will serve: Residence Apartment House-F Commercial ❑Trailer Court ; ] i Motel ❑Other ----------------------------------------•--- r Garbage Grinder ------ Lot Size -_�_t �-�.---------------------- Number of living units:.____L----- Number of b�e�dr/oom�s7__�- Water Supply: Public System and name -------- --------------------------- __-_____----------- -------------Private ❑ Character of soil to.a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat El Sandy Loam El Clay"Loam El Hardpan ❑ Adobe X 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,] PACKAGE TREATMENT [ ] SEPT+C TANK j }( Size------------------------------------------------ Liquid Depth ----------- -------------- Type� Q4-- --- Typed '�-� --- No. Compartments -- ------------- (.�l afienal- `a' j Distance to nearest: Well ____. ---------------------Foundation -.250------- --- Prop. Line -_I- --------- LEACHING LINE L ] No. of Lines --------Z,----------- Length of each line--__ _ __.__- 'D' Box --- ---- - Type Filter Materia _________-_____-____ Filter __ Total Length _fQ ----• ------- Material Depth ter aterial --- ------------------------------- •,-------•- � Q �.E _. Distance to nearest: Well -- -5------------- Foundation .- -- ------- Property Line _ -- SEEPAGE PIT [ ] Depth - .---------- Diameter _36-1---- Number _.--��___----___-___ Rock Filled Yes ] No i❑ ,r r Water Table Depth if ----------Rock Size --_a�-'Z------------------------- ----- ----- ' l Foundation --- ---------------- Prop. Line __.-----------•------- Distance to nearest. Well _____�__ _�--- - REPAIR/ADDITION{Prev. Sanitatio+ Permit# -------------------------------------------- Date j Septic Tank (Specify Requiremets) --------------------------------------------------------------------------------------------------------------•-•------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ► f --------------------- --- ------ - -------------------- - ------------------------------------------------------------------------------------------------------ ------------------ r ------------------------------------------------- 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: t "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 I t1 w TitleBY -------------------------- el��er than FOR DEPARTMENT USE ONLY I - DATE !� ------------- APPLICATION ACCEPTED BY ----- ---=�--- -''�'t --------------------------------------- A7 t BUILDING PERMIT ISSUED ------- - ----------- --------- �A -------- --------------- ADDITIONAL COMMENTS - - --------------- -------- ------ ' - � ------ --------------------------- ---------------------- _-��- -- -'� --- ------------------------------------------------- --------- ��---�---- --- -=---- - ---- ---------- ----------- ------------ ------------------------------- Date �� --- --- ------ Final Inspection by. l SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M