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`30 FOR OFFICE USE: - APPLICATION EOR SANITATION PERMIT (Complete in Triplicate) Permit No _-7.1_,.-3t9---- ---------------------------------------------------- -------------------------------------- ______________ 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 construct and install the work herein described. This application is made iinocomplia ceE o o itthur ty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION TRACT ------------------------ Owner's Name �' i-!�_ ----- ----------------------------------Phone-------------------------------•----- Address �_S +p_.. 110 ------ C- - --------• City �� , - ----------------- ------- ---- Contractor's Name __f _,5 __.- ¢_-- .� ----------License #,1d2,1 _�_r�__ Phone Installation will serve: ResidenceApartment�House,❑ Commercial ❑Trailer Court ID ' Motel ❑Other. Number of living units:--- t__;_ Number of bedrooms 3-----Garbage Grinder ------------ Lot Size__--- ________ Water Supply: Public System and name ----&.t---&J - ---------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat n-- Sandy Loam ❑ Cfay,Loam 1771 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,) I PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size ______________________________ Liquid .Depth --f�f�`--_________ I Capacity Xlvap----- Type _._'-- Material-1:.�'i+�-_r____ No. Compartments _---.,____._._:_ --- �¢ Distance to nearest: Well ------_------,�-- ------- ----•----Foundation ---------------------- Prop. Line ---�---:-------- LEACHING LINE [ ] N. of Lines 0_ 4�©-_Ael► tCi`o'f each e _____- Total length ----------------------------- o. 'D' Box _-__�___--- Type Filter Material Rf?"-- ___Depth Filter Material ----------------------_________ Distance to nearest: Well ----_--------______ Foundation^-i-:------_-___-__ Property Line SEEPAGE PIT [ ] Depth _ _________________ Diameter ------------__--_ Number;----------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ----------------I-------------------------- -------Rock Size -------------------------------- Distance to nearest: Well ---------------------------- ----------Foundation -------------------- Prop. Line -------- ..... -- rREPAIR/ADDITION(Prev. Sanitation Permit# --------------------------- ------------- Date ---------------------------------- Se p tic ------.--------------------------Septic Tank (Specify Requirements) ___________________. II Disposal Field (Specify :.Requirements) ----------------'------------------------------------------------------------------------------------------------------ ------------------------- ---------------------------------------------------------------------------------------------------------------------------- ------------ --- - -------------------- - -- ---------------------------- - ----------------------------- -- (Draw existing and required addition on reverse side) I hereby certify that I 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- 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 Compensation laws of California." fSigned -------------------------------------------------------- ---------------------------------------- Owner By - ----------------------------------------------------------------------------------------------------- Title -------------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ----- ----- ;.; DATE 2- -- ----------- BUILDING PERMIT ISSUED ,.------ --------------- --- ------------ DATI --.---- -- /�pDITIONAL COMMS TS . - ,�'��'L` �.!/� --- --------- -- ----- - --- - --" `• P�_` a- , Qo� - - - - - - - -- - --- . ° ------- --- --------------------------- --------------------------------------- - --- ---- - -- ---------------------------------------- - - Final Inspection by: -----------------------------v -�---- --------------------- ---- ------- --------- ------Date _cI/Jx.62---------------------------- SAN --------- ---- --•------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,