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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f es` -- , Permit No: —Yj6- (Complete in Triplicate) ------ ------------------------------------------------- iThis Permit Expires 1 Year From Date Issued Date Issued �= 776' 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 CountX Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -- �f - ,-__--- --------- t------ -- ---- - CENSUS TRACT --- --------------------- ` S Owner's Name ----�`"- - - � ------ - --- - - ------------------------------------------------Phone ----------------------------------- Address ---------------- --- - - - ------=--- ------------------ - ------------------- City ------------------------- ----- --- Contractor's Nam .-_. t �]._✓_�&21kense # ° �� Phone��____S0_# Installation will serve: R idence-❑ Apart ent House❑ Commercial ❑Trailer,Court,,;❑..._ _r,r. .-...«..�.-.. IVl77 otel ❑Other -`- Number of living units:------f----- Number o bedr oms _._f __Garbage. Grinder .__.---_____ Lot Size --_-.-__________________________{_--_-___ Water Supply: Public System and name + ;tC—- --_------------------------------=----=�-`--- *----------------------------Private ❑, Character of soil to a depth of 3 feet: Sand' pssilt.❑' Clay ❑ Peat 0 Sandy Loam ❑ Clay Loam ❑ _ : Hardpan ❑ , Adobe Fill Material"-----L ---elf yes type"""'_.--_-__. __._____- t (Plot plan, showing size of lot, location{ bf system in relation to wells,lbuildings, etc. must_'be placed on reverse side.), NEW INSTALLATION: (No septic tankorseepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC:TANK;[•] Size---------k-------------- --------_------------ Liquid Depth ------ --------------� ` ------ Material------ --------------- -No. Compartments ---------------_- Distance -------------- # Capacity -----=-- ---=------ Type -------- --- Q :x. .� Distance to Inearest: Well --------------- ------_------�---- ____Foundation ______________________ Prop. Line ___________'___._____ - rI LEACHING LINE [ ] No. of Lines --------------_--- Length of ach lin67-4-.,_.--------.--------- Total Length -___--.---_.______-_-_____,. t S D' Box ------ ____,�7ypeTiIter Material ----__._._''__-_--_-Depth Filter Material __.__.____________________________________ t Distance to nearest: Well ----- _:_---- 'Foundation ------------------------ Property Line. ________-.___-____....__ a r Ct SEEPAGE PIT [ ] Depth _____________,__*__: Diameter == ------------Number _, _-____. ._-._. _ ___ _________ Rock Filled Yes ❑ ._ No Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -___--.---_____________________________Foundation -------------------- Prop. Line -________-___-__ ----- t REPAIR/ADDITION(Prev. Sanitation Permit.# -------------------------------------------- Date ----.-----------------------------) i i Septic Tank [Specify Requirements] ----------------------------------- isposal Field (Specify Requirements) ---Q-- �___ _ __ ----..._____ __ _ ___=;-7 ---------- ---------------------------------- ,--- ---------- (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 f as to becom t to kman's Co nsatts of alifornia." Signed _ _ _ i- . ' ----- Title - . --------------------------------- _ (If other than owner) FOR DEPARTMENT USE ONLY �Z APPLICATION ACCEPTED BY -- -_- -- ----------- -- ------ DATE .---- . ------- --------------------- BUILDING PERMIT ISSUED ---------- 1. p ---:---- '- ---------- ------------ ------------DATE ------- --- -------------------------------------- --- - -------------- ADDITIONAL COMMENTS X� ---------�Ae------- -`------------------------------------------------------------------------------ ---------------------------------------------------------- -- ----------------------------------------------- ------------------------------ --------------------------------------- ------------------- ------------------------------------------------------------------ --- ----------------------------------------------------------------------------------------------------------------------------------- -d-- -------------- -- ------------- ------ -------- ---------- - ----------------------- ------- Final Inspection by: .--- - ------ -------------------------- ---------------------.Date ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M t