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FOR OFFICE USE: _— - ------ /�� ��= APPLICATION FOR SANITATION PERMIT f - ------ -------------------------------- _ (Complete in Triplicate) Permit No: . �--_!7� ............. . t 9 _61- --------- 9- - This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to f described. This application is made in compliance with County Ordinance No. 549 andnstrucex stingnRulestalndtRe work egulations.rein JOB ADDRESS/LOCATION _-14 C> _ _r ". -"" ..CENSUS TRACT Owner's Name -----' Address ------------ --- - -- ----- ---------Phone -- _7_7_s� - ------------------ --- - Cit Contractor's Nam Y --- ------------------ --- - ---- _ Installation will serve: - --- Phone Residence Sl Apartment House'E] Commercial []Trailer Court 0 Motel (]Other .._" Number of living units:-___/____ Number of bedro s .--Y_ " Garbage tinder ___--__ "-_ Lot Size Water Supply! Public System and name pp Y ---------- Water of soif'to a depth of 3 feet: Sand'� gilt Clay ---�`-- --•-------Private � { ❑ Peat❑ Sandy Loam Ej Clay Loam Hardpan AdobeFill Material ------------ If es, type YPe ----------- (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 permitted if,public.sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size - 1 ----------------�- Liquid Depth ------ ------------- Capacity -- ---•-- Type ----------------- Material-------- - No. Compartments i ___ _ ______ ' Distance to nearest: Well -°_-- ---Foundation ---------------------- Prop. Line -----•---- 1.---- . LEACHING LINE [ ] No. of Lines � V ------------------------- Length of each line--------------------- Total Length ------------ -------- 'D' Bax ---- -_--_- Type Filter Material --------------------Depth Filter Material ---------------- Distance to nearest: Well -__A ----------- --- Foundation _____________ __ SEEPAGE PIT ------- Property Line I - Diameter Depth -------- Number -------- ------------------- Rock Filled Yes Water Table Depth ------- # ❑ Nolo - i, -------Rock Size t Distance to nearest: Well -.___�___________ __ � _, I ------------------Foundation - ------ Prop. Line �---•-- -------_iREPAIR/ADDITION(Prev. Sanitation Permit __.____"_ ---------------------------- Date Tank (Specify Requirements) ----- -------"--------------------------- ------- "_ --------------------------- Disposal .l Field (Specify Requirements)_--------- ------- . -------------- ------------------------- __" "--" "___"_ _. -------------- ___ T C _ _ - ��-�- I ------------------------------ (Draw existing and required additioncog everse side) I hereby certify that )shave prepared this application and that the work will be done.-in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of thehSan Joaquin Local Health District. Home owner or licen- sed agents signature certifies'�he followin g` --.�... `h 3 t "I certify that in the performance of the work for which`'#his"permit is issued, l shall not employ an I as to be ub}e,t�OrZ,n' Com p y y person in such mannerp tion laws of California.'Sign *_'_: r V " ! = ---- ------- � BY ------------------------------------- ✓ - ` Title ------ (if other than owner) i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------------------- BUILDING PERMIT ISSUED "-_ ._______ __ DATE ADDITIONAL COMMENTS /'� _ l� �5' /uc _ - j " = --------------- --------------DATE - ---------------------------------- - ------------------ ------------- ----------- --------- ------------------- --------- -------------------------------- ------- --- -- ----- ------- ----------------- ------- ----------------------- --------------------------------- ---- - - -------- --- ---- Ina Inspection b ----------------- �f y' Vie- .- - ---------.------------------------------------------------------- - - ----- -----.Date --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M�