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FOR OFFICE USE: --------------- ----- -----4�-------,--- J>--- ------- APPLICATION FOR SANITATION PERMIT L~ l 7_ (Complete in Triplicate) Permit No. - _ e -. -- - . .. . I This ate Issued Permit Expires 1 Year From D ---------------------------------------- ------ �-- ----- Date Issued Appfication 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: k JOB 'ADDRESSjLOCATION ------ -- " rte ` s��r 1�d "` Owner' - CENSUS TRACT l31 –leo--v s Name �{I r Phone /1 Address ----- -- ----- -- — ------------------------------ -Qi------ - .- -- .. - ---•---- r.Q . . . -------- CityV Contractor's Name " - -- wop Installation will serve: .y\Residence Apartment House Commercial ai��C � � Phone � _70 �.� ❑ P ❑ Court ;❑ ' Motel ❑ Other -�A,6&> Number of living units._-._--__ - Number of bedrooms ------------Garbage Grinder -------- -- Lot Size _-- Water Supply. Public System`and name _ F PP Y .;;--------------------------- --------------- ----Private 19 Character of soil to a depth of 3 feet: Sand' Silt Hardpan ❑ Adobe Fif ate al �__Sandy a! d es, type Loam Clay Loam I ❑ Cla ` (Plot plan, shown e .. A - �g:size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ' NEW INSTALLATION' "' (No septicttank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT �f 4 C 7 , SEPTIC TANK t Size-/�",'t 49-` �' ' ---------- Liquid Depth --- Capacity -3*00341.Type ---I-•--------- Material-egy►x No. Compartments ............. + I Distance to nearest; Well a _.._-"_"Foundation __--/Q- - a _ �J ��t Pro . Line �!f ------- J No. of. Lines ---..--L-- ---"__--- 01 Z Len th of each fine -_'___er---b-ed---_ Total Length _JQ ii/---- 'D' ,Box __.. Type Filter Material { I ( f YP Depth Filter Material --------r ----------- k' ft t -Distance to nearest: Wel! ---- CJ_� Foundation ---- (� ---- -- Property SEEPAGE PIT' ' 4 `T x (( p rty Line __ •----- �`] Depth "r Diameter Number . Rock Filled Yes ❑ No i[} l •}. "Water Table Depth ------------------------------------------------Rock Size t Distance to nearest: Well "__-"______________________"_--_" Foundation -"__-."- r F ---- - Prop. Line-----------•---- REPAIRJADDITION(Prey. Sanitation Permit# ------- -------------------------- Date..-- --------------- J ,--. i -Se tic Tank (Specify Requirements)P {. P Y q i1 --------- - �J.�APf1_--- --l�G.-r-- --------------------- I- 'Disposal Field (Specify Requirements) ------- ----------------------- A41, ��-� L�----------_ "" - / ,— -------- r . fry' - __"_.""._-"___""-_-_--__""--"-----------------------------------------------------------------:--------------------------------- -- 4 • -Y• --------------------- _ ---------------- -----------------_-------- __""__-- __" __ •__--"--""-•_-•-__•-_._;:----------------------- - --- - --- ""-- ------------------------------------------------------- (Draw _ _(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 Son Joaquin w' County Ordinances, State Laws, andi Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: '"II 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 ----- ------- i o ---------------------------- +-_-- ------- Owner BY = Title ------ (if other than owner) FOR DEPARTMENT USE ONLY tI F "APPLICATEON ACCEPTED _------- ---------- BUILDING . _PERMIT ISSUED -'- - = 4 --- -. DATE 2"_r6�. ------------------- --------------------------------ADDITIONAL COMMENTS t -- = DATE -.. - ------------------------ --------------------------- ---------------------------- - - -- ------------------ - - - t - ; --------- -- ------------------ ------ -------------------------------------------------- "------------------------- 'Final� ' - _ ......................................'---- Ins ection b r^ " P - # ------�------=- --- _ _� "Date ----- ------- - ------- - --- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 7-'68 Rev. 5M