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4 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a �. e � Permit No: .��•-.5--�-�-� ---------------- ----------- -- -- �?10 � (Complete in Trip 'state �------- ---- ---------//_OS Date Issued ter= ------T This Permit Expires 1 Year From Date Issued 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 County Ordinance No. 549 and existing Rules and Regulations: + JOB ADDRESS/LOCATION .--��.�--- �� ' ------------CENSUS TRACT ----------------------- - �. _- @- --- Owner's Name�f�i _-71! a�.til '. ,� 1�t/ ��r^^,t Phone - - ---- ---.-. city _ F ''�`ci F Address - -_ - Contractor's Name _-_-, ' "-------------License ;ZS'# - Phone Installation will serve: Residence ❑ Apartment House❑ Commercial Yrailer Court ',❑ d ( Motel ❑Other r _Garbo `--xf00-_j --- Number of living units_____________ Number of be ooms -_____ ____ ge Grinder ____________ tot Size --_._ __ ` -------- ------------------•--- ------------ ------•---------Private [:1 Water Supply: Public System and name _________ ___ __�_----------,------ --- - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat El Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe fill Material ------------ If yes, type ---------------------------- t (Plot plan, showing size of lot, location of system in—relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION:? (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) cP� NJ PACKAGE TREATMENT { ] [ Liquid Depth -_--------------•- ------ SEPTIC TANK Siie-- -f 1C----�-------- --------- -- -- q p � . g Capacity- Type ---�Ft Material---------------------- No. Compartments -- =� c - - i Vr1' _ Prop. Line --- 7 Distance to nearest: Wella___-- 4 -- ----- Foundation ---- k -__ } -- { LEACHING LINE,' N [ ]F o#sof Lines ---_- ------ - ------Length of each line___-__ -------------- Total Length ----- 5-V - N114�f .f . D' Box . ^-- Type Filter Materia *------Depth Filter Material -------,� ---•------•----f I jr ----------- meter ----- Distance to nearest: Well ---&'2ir ---- Foundation ___ fid------------- Property Line ____ SEEPAGE PIT [ ] Depth Via._'------ Diameter �_- -__--- Number ______________�� Rock Filled Yes No 0 � Water Table Depth --------��.Sr-------------------=---------Rock Size __�.��C-�- -._-- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- jpis;. 1 ---- Date ---------------------------------- REPAIR/ADDITION ) (Prey. 5anitption Permifi# ---------------==-=--- f . Septic Tank (Specify Requirements) ------------------- ------------ ------------------------ t Disposal Field {Specify Requirements) ----------- -- ---------__ ----------------------- w o r i� ___ - ' - , (Dtdw existing and required addition on reverse side) n 1 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- I 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 as to become su 'ect to Workrgaan's Compensation laws of California." Signed __. / --------------- Owner ---- F Title -_ '---------- ---------------------------------------- BY ------------------- - (If other an owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _--- - --. DATE __.S''-A:77-—------••---------- -- - ---- ------- ---------------------------------------------------------- - BUILDING PERMIT ISSUED ---- -------------- ----------------- -------------DATE --------------------------------------• -- - - ----- - ADDITIONAL COM ENS-- - -- -------- -- - - ----------------------------------------------------------------------- ------ t - - ------ ------------------------------------------------------------------------------------------------------------------------- - -- --------- ------ ------ ------ -/----- --- .._ -------------- - - = - -------------------------------- -------- Date Fina! Inspection by: -- _ / SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M __