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E /- F R OFFICE USE: / APPLICATIA FOR SANITATION PERMIT - r�f �- - �/� -------------------- Permit No.7l-JW✓_Z------ {Complete in Triplicate) 4 ��AW;11 ,' " .�, Date Issued 1 f7� - — � �_ This Permit Expires 1 Year From bate Issued 4 -17 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�complian�ce ithr o my Ordinance No. 549 and existing Rules and Regulations: Yp, x Y ha" __ _�Q _ .fit t -. a---------- - `--= --------------.-CENSUSTRACT -------------------------- JOB ADDRESS/LOCATION : �__'__:_ ., Owner's NameC_.�.�r_ __ �/= ------� = Phone ---5-' .�� ---- ----��---�---- --�_-[-"'(�--------------- -------•--. City,��<��-G�---'-------------------------------------------• Address ____-__ .. .. Contractor's Name ?_. °------- �- -----------------------=--------License #1�_1_ - - --' Phone � �J----2' "-1-- Installation will serve: `i, Residence partment House❑ Commercial {-]Trailer Court [Di' Motel ❑ Other ---------------------------------------- Number of living units:.----- ___Garbo e GrinderY_s.?,______ Lot Size ,��rr y J i ------ f Number of oo s g fF f;J w. �_Com'__ `-tom � _ ------ 1. j -----Private ❑ Water Supply: Public System and name ------ - ------ -------------------------------Character of soil to a depth of 3 feet: Sand' Silt Clay Peat Sand Loam "Clay Loam :❑ i p ❑ ❑ Y ©- ❑ Y ❑ Y Hardpan ❑ .Adobe-dr Fill Material __ iC __ If yes, type ----------------------------- (Plot _---___ ___________________(Plot plan, showing size of lot, location of systeml.in relation to wells, buildings, etc. must be placed on reverse side.) I sewer.is available within 200 feet,) �1 NEW INSTALLATION: - {No septic tank or seepage pit permitted if public PACKAGE TREATMENT [ ] SEPTIC TANK r ize ...________.._. Ligdid,Depth � ---------- __,_.._ Capacity ..5J-�`_�-_____ Type _ " Material_IEG/}, G' No. Compartments Distance to nearest: Well,-------i-______________________Foundation • _`�______-_-___ Prop. Line �________:......__ r. LEACHING LINE No.-of Lines`_` ` --_ -' : Length,.of each line- -. j .___ Total .Length . .. . ............... 1 Type Filter Material ` �_'�________Depth' Fi(ter,.Material ____ J_.______._ D Box`..1. ------------------------ Distance o nearest: Well ________________________ Foundation _Ji1__l______ _',Property Line _�_.__________........ PIT rV Depth . r ___I-_____ Diameter �,'_t�° _'Number -------------- SEEPAGERock',Filled Yes E3---No I❑ k A'I Water Table- Depth -�------- i b ii kr --- - �------------------------------Rock Size -----r-- -�-�---�----------- Distance to nearest: Well -_-----____`---—�------------------Foundation -------- Prop. Line ..S_.....________-_! REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------._-------------.. , I 4 . Septic Tank (Specify Requirements) ---------------------------------------------------------------------'----- ----=-------- ----- ------------•------------------------- Disposal Field (Specify Requirements) = --------------------•-----------------------------------------------------------=-------------:---------------- --------------- , t ----------------- -------------------------------------------------------------- ---------------------------------------------------------------------- --------------------- `--------------=--------------------------------'------------------------------- --------------- ---------------------------- j(Draw existing and required addition on reverse side) i 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 R "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner k as to become subject to Workman's Compensation laws of California." Signed - ------- ------ ." ' _________________. Title _._��.;�. ..F_".__._.____.____.__________. (If---,h'r than owner) s r OR*DEPARTMENT USE ONLY / "• APPLICATION ACCEPTED BY ---------F- -------de-I ---f-------------------------- ------------------ DATE ----BUILDING PERMIT ISSUED F �J DATE ------------ ADDITIONAL COMMENTS . 7/ ' (�" "'" '�`- !* --- ------------------------- Q `7� -- --------- ---- ----------------------------------------- _ _ _ -------------------------------------------------- -- - --------------------- ------- - p - - - ---------=------- Final Inspection by: ---------------- P - -------------------- - ---- ------------------- ---- Date _. /� � 71 -'-i SAN. JOAQUIN LOCAL. HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -t