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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ~ T Permit No.2s_ __�O0• (Complete in Triplitafie) """"""" " _________________ This Permit Expires 1 Year From bate Issued 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 ------- � -. __,! A _ -/ ------------------------------CENSUS TRACT --------------------..._.. /- Owner's Name ---•- 4------ ------------Phone Address ----------47,---G-Q------�--I - - - ------ A,4_ ---------- ------------------------- City -��ll��t�C�--------------------------------••-•........ Contractor's Name ------._Mr,y--F(,14/,G -------------------------------------------License #o?.� � __ Phoned.... Installation will serve: Residence N Apartment House❑ Commercial ❑Trailer Court i❑ rr Motel F-1Other -------------------------------------------- Number of living units------!_____ Number of bedrooms ________Garbage Grinder ------------ Lot Size --------I-_______________ Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay 'F] 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 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK I ] Size-------------- -------------------- ------------ Liquid Depth ____--- .................. �A Capacity -- ------------------ Type`------------------ Material---------------------- No. Compartments ------ ------_-----• G Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- S LEACHING LINE [ ] No. of Lines ______________ ______ Length of each line---------------------------- Total Length ______.____-_______________- 'D' Box ------------ Type Filter Material.____________________Depth Filter Material ______________________-.__-----__ ........... Distance to nearest: Well __________________I-____ Foundation ------------------------ Property Line ........................ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ❑ Water Table Depth ---------- -------------- -•--••- ------- -.._Rock Size 0G to nearest: Well ________________________________________Foundation -------------------- Prop. Line .____.____..__....__. C REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------.--_---------------------_) Septic Tank (Specify Requirements) -------------------_--------------------------------------------------------------------------------------------- � Disposal Field (Specify Requirements) --------------------------------------------------- - -•-•----------- ---------- '- ------- --� �' `1` `�.r.�11� 1� �- `/ --- ----------- C --------------------------------------- ---------------------------------------------------------- e-------- ------------------- --- ---------------------------------------- (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 Sar-Joaquin LoWllealsh District. dome owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit isaissued,"I shall-nbt..employ any person in such manner as to become subi to orlon 's.Com0ensatian laws-of California* Signed � `�'� V= -------------� �-------------------- Owner t ..,_--..W., By ---------- - --- ' wN- 7itie, r+ -- ------------------------------ --------- --------- (If other than owner) +� FOR DEPARtMENT_USE/QNLY APPLICATION ACCEPTED BY __.______ - _ _ F 2— 7J 77 ._. DATE --- ---------------- BUILDING PERMIT ISSUED - _DATE ------------- K- � ---------------- ADDIT ON eClsMMENTS /Z-!"�-_�3 C .cfi�a x,-,_ � - �. .�.� = r�r -- - ' --------------------- -- --- --I r �i �► t'� J !...,+ dcm - - ---------- W t. FinalInspection b '--------------------------------------------------------------------------------------- - -- ''" pY' - -- -----tom ,�d.4�,� ---------------------------------------------------------- ----- Date - -?5 AN JOkt- L AL ^HE/�L 1S E. H. 9 1-'68 Rev. 5M �� J ! �