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FOR OFFICE USE: APPLICATION)-FOR SANITATION PERMIT Permit No. "71�-V y �7 ---------------------- ------------------------ (Complete in Triplicate) ---------------------- Date Issued _ --- ----- --------- —171 --------- - s -�_�.__ --------- ------------------------------------- - - This Permit Expires 1 Year From bate 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: .�.l.=..�--�� -- --�1��`��--�/-�--.<-�-� -- _- ,��rl .CENSUS TRACT ----- -------------------• JOB ADDRESS/LOCATON --Phone ------------------------------------ ? � ---------------------------------------------------. Owner's Name -� - - ---------------------. Cityf1 Address �� ----- p---- - -��- - ---��----------- Contractor's Name _. -_V -�--'- ---- --- -------------------------- License #12<102-VO, Phone Installation will serve: Residence Apartment House-M Commercial ❑Trailer Court ,❑ Motel ❑ Other _ - f -------------------------------- --- - - - Number of living units:--/------ Number of bedrooms -u _-__Garbage Grinder ". _�e?Lot Size, -y-------Private ❑ Water Supply: Public System and name j,,�_x � � � � �"-f""""" Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) . � PACKAGE TREATMENT { ] SEPTICTANK Size.__ -_,�-�-.��- ----------- ------- Liquid Depth -��_"----•---------- G1 �� - �aterial. - -'--- No. Compartments .�:- .- -_---- g? Capacity)% TYPe (�+ Foundation - --- Prop. Line, �.�.•--------- r Distance to nearest: Wel �--�----" --. Length of line-__ .__ �_ Total Length .A:P211---------•- LEACHING LINEA No. of Lines "-- -- g ----- -------=-- '�_aDepth Filter Material ateriaI .,/e_--/-------------------- --------- Q, D' Box " __ _ Type Filter Material l`�,, —/, __ Foundation Property ;Line __ __.-•---------------- Distan a to nearest: Well -'_"�`=--------- -� ----�� - -- _ �y Diameter tel" Number _.___ Rock Filled Yes No 0 SEEPAGE PIT Depth - --- _�� Rock Size Water Table Depth ------ ------------ Distance to nearest: Well -----_`�„"� ---.-------Foundation - e �i �' 'Prop. Line -t ....... ) ' REPAIRfADD1TION(Prey. Sanitation Permit# -------------------------------------------- Date ------------------------ , A.. + ` _ - - - • _"-------------------------- ___-_____.___________._ Septic Tank.{Specify Require ------- ments} ------ ---------------------- - Disposal Field (specify, Requirements) "--"-----••---------------------- - ------------------------------- --------------- i I ---- ----- ----------- ---------------------------------------------------------------------------------------- i (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- M 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 i as to become subject to Workman's Compe tion laws of California." Signed ------ ----- ---- Owner :. ---- ---- -------------------------------- jitle r ^, --------- ---------- ------------------ - z ' (If er t an owned -- E TMENT USE ONLY ----------------- APPLICATION ACCEPTED BY ------- - - ------" DATE------ '��-7-r------...... BUILDING PERMIT ISSUED . --------------=------- DATE .... ADDITIONAL COMMENTS --= ---- -- ------ ----------- r~r71-------------- - ---' --------- = -------` -------- G --------- - ----- -- ---------------------- ----------------------------------------- ------------------------------------------------------=------- Final Inspection bY- --------------- --- -- - - - -•; --------------�.- -------------------- ------------ Date ' JO UIN LOCAL HEALTH DISTRICT F. H. 9 1-'68 Rev. 5 ~' `