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FOR OFFICE USE: �, /0/- - 3 e APPLICATION FOR SANITATION PERMIT �/��-3 (Complete in Triplicate) Permit No. .__._________ ------------------- ---------------- ___&D---------- Date Issued _�__�� --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is min comp lance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-- ---- ---- ------- - ----- -- `C -- _-. f._------;016 �e_/7CENSUS TRACT ----*I�------- k Owner's Name ---------------------------------------------- -------Phone ----- fi. Address ----- �� ------jV,, ------------------------ ------------ City --------------------------------------- ...... Contractor's Name --,/ ._'�_�r_.�27C_'---------------------------------------License #�a r� �'_ _ Phone X71 __'% / Installation will serve: Residence-Apartment House❑ Commercial ❑Trailer Court !❑ Motel ❑ Other =------------------------------------------ ` 01Number of living units:__.----- Number of bedrooms _______Garbage Grinder -IY40._ Lot Size /, 1___��_____________ Water Supply: Public System and name ' �elr Ae-.-.f- �__._- -----_ ____Private E]- -------------- -- - 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 ---------------------- ----(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 p lb�lic�rsew�er is available wit-h�in 200 feet, PACKAGE TREATMENT SEPTIC TANK'� �f Size_$1 0? ---------------------- Li q d Depth ____________.____. ` Ca pacityI.Xt9:47------ Type �� __ Material /10-------- No. Compartments Z-_----_____------ "\" Distance to nearest: Well --------- .-�- _-"'�`""""�Foiinclafiion ------------ Prop. Line .,f-l-_�_1:-------- LEACHING LINE No. of Lines - �-_----------- Length of each line____ � Total Length .___�_►�`� _.�......-_ } 'D' Box�i'a- _ Type Filter Mate rial` 11Depth F+Iter .IMateriaf ' ------------------ .____.-____-_ Distance to nearest: Well _____ _____________ Foundation ___ _ ___ _____ Property Line -___V__=-�, 'SEEPAGE PIT [ Depth Diameter __-- Numbe -------- • � . Felled Yes, ` No i❑ do Water Table DepthRock Size'/-I --------------- 1. �or Distance to nearest: Well ----------------- ----------------------Foundation - Prop. Line--_0__.___........ REPAIR/ADDITION(Prev. Sanitation Permit# _____________________________________________ Date -------------- -44 - + 1 Septic Tank (Specify Requirements) -- !---------- ---- ---------------------------- Disposal Field (Sri°e`cifylRequirements l I = s, + ------------------------------------------------------------ --------------------------------------------------------------------------- I--------------------------------------------------- (Draiw existing and recpired._.addition on-reverse-side) �... 1 hereby certify that I have prepared ths,,,application,,anA 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- -4i 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 subject to Workman's Compe sation laws of California." �It Signed --------------------- - Owner . --- ----------------------- ,,_ j BY-`------ ---------------------- -- ------------------ Title -- ---------------42�'�-- ------- ------------------ -- ------;-TZEPAVMENT (If o#her ttUSE ONLY #APPLICATION ACCEPTED BY ------- - ----- - - DATE _..___ 7..r-_7/__---.-.___-_____ BUILDING PERMIT ISSUED --------- - --- -- - -�� -------- ------------------------------------_- -------=------------ DATE ---------------------- --------------------- fi=,.-ADDITIONAL COMMENTS, - ---- --------------------------------------------------- ----- - -- - - -- --------------------------------------------- �. / �Y- - -y�- ----- ----9_,V M-W..-------6�--------7-°-.... -- ------------------------------------------------ ------------- ------------p---------- y'_. ✓ _ _ _ _ ----------------,- 7-- ------- Final Inspection b Date - ----------------------- S -------- -- -- S JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M x .y. .I