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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------ --------- f. Permit No. ------ ----_ k----- ----- - --- 4 (ComRIete in Triplicate) -= 471- -:______ This Permit Expires Y Year From Date Issued Date Issued - _" --- -3 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 ma,Ik in compliance with County Ordinance No. 549 and existing Rules and Regulations: 2fa. g iS 6 r►2� A-�A) : Zs s -- oS�- 17 JOB ADDRESS/LOCATION ___._ 1jIln-- ----�y--M-•--� -� '��_'�_-_.0URj_1A_M___&dqNSUS TRACT _-S'.�5---------•-�------ Ownerr''s Name ------------------GRR`{ ------------- ------------------------- -------- ------------------------- -Phone ---------------------------•--•--- Address - ------------------------------ - - --- Cit Contractor's Name -------rpgI. Y__ 5T__-GO------------------------ -- ------.License # 7-5-7170,9------ Phone Installation will serve: Residence Apartment House❑ Commercial [ Trailer Court Motel ❑Other Number of living units:-----[------ Number of bedrooms __5------Garbage Grinder ------"__ Lot Size -------SA ---_ Water Supply: Public System and name ------------------------- Private --------------------------••------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ F .r Hardpan ❑ Adobe.K 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.) W NEW INSTALLATION: L_- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) � PACKAGE TREATMENT [ ] SEPTIC TANK' r l [ ) Size I �----------------------------- Liquid Depth --- ----------- --------� Capacity -1-900--------- Type -t�-�p�t----- Materialjoju 't ---- No. Compartments ----'?�=.......... Distance to nearest: Well -------/ -----------------------Foundation ------14----------- Prop. Line __•_,--•_ ' LEACHING LINE [ ] No. of Lines ---------3------------ Length of each line--------! ------ ------- Tota! Length :---�-��----------_••-- 'D' Box 'eS---- Type Filter Material 1+Fp_Y-_____Depth Filter Material ---------)9 Distance to nearest: Well ----100- ------------- Foundation -------690----------- Property Line '_------_--•• SEEPAGE PIT [ ] Dep -------------------- Diameter ------------ --- Number -.---------_ -- Depth ______________ Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size Distance to nearest: Well -----------------------------•------ --Foundation -------------------- Prop. Line ------------------ REPAIR/ADDITION(Prev. Sanitation Permit# --------.----------------------------------- Date ----------------- -_--- - -- Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ______________ ---------------------------- (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: "I certify that in the peidormance of the work for which this permit is issued, I shall not employ any person in such manner as to b c me subject to or an's Compensation laws of California." + Signed Q,n1v- a- ----------------------------------- Owner By ------- ----- ------------------ ---- --- ----- - (I other than owner) ---------- ----- Title ---------------------------- FOR --- ------ ------------ --- FOR DEPARTMENT SE Ly APPLICATION ACCEPTED BY ________________________ _ - ------ .......... - ----------. DATE ----- - --��-� I---------- ------- BUILDING PERMIT ISSUED ___________________._ ------ ... ........ --- -- DATE ---- ADDITIONAL COMMENTS --------------------- ------------•----- ---------------------------------------------------------- Final Inspection b P y: ------------------------- ---------------------------------------- Date -$��--------------=------- ------------------------- SAN JOAQUIN LOCAL HEALTH &:--- E. H. 9 1-'68 Rev. 5M N