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v1, FOR OFFICE USE: �; Y APPLICATION FOR SANITATION PERMIT µ (Complete in Triplicate) Permit No: 75--------------- --------------------------------------------------------- -------------- This Permit Expires 1 Year From Date Issued Date Issued _-9= _`----_ y ----- 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 .----..__ G_3_____ S_,- f y / - 7`t'' -------- - ------ 7�--- ----- CENSUS TRACT Owner's Name ........ -h-c!--------�5tC_04e_WA---------------------------------------- � -------- -------_--- -- ------Phone _�`_77�--(�73-7- Address - ✓�--- -- - -lamt - --------- Ylt tt1------------------- City ------ �' Contractor's Name ------ .1.� ��/� ----- - 1 License # - Pho e -3J1Yr, Installation will serve: Residence CO Apartment House,❑ Commercial.❑Trailer Court i❑ �4 I Motel E]Other � Number of Irving units:_- -bi �--_ Nuber of bedrooms -__-- --_Garbage Grinder -------__--- Lot Size ---_._�3j� pa --------------- Water - -Water Supply: Public System and name ------------------ ---- - Private -. ---•-- Character of soil to a depth of 3 feet Sand'❑ Silt.[] Clay ❑ Peat❑ ��Sandy Loam ❑ Clay Loam t a ,Hardpan ❑ Adobe Fill Material ------ If-yes,If-yes, type -----------------_-- I 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: t 'pgppermitted public sewer is d if iit e a " (No septic tank or seeavailable within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKI �, Size = ---------------- - Liquid Depth ---1: --------- ---- Capacity _jE ;J------ Type 'cG /. Material-------- No. Compartments --------- 'I 1 t Distance to nearest: Well _---.-- __, ___ ___________Foundation ---aQU�___-__ Pro p. Line LEACI-LING LINE (� No, of Line W I . _a _-_ -.- Length of each line------- '1F Length D' Box ---Yle_�- Type Filter Material - _xu-__t`.Depth Filter Material _--_-__ .g-�r.__._.______•- Distance to"nearest: Well --------V ----- Foundation ------'10 Property Line 0---7F........... } SEEPAGE PITi. ( i Depth ----- ----- Diameter _- - --___ Number ----------- _�Z----------- Rock Filfedr Yes .�. No -1 Water Table, Depth ------------ -- Rock Size --------------- 1- Distance to nearest: Well ------_ ____ ________________Foundation f___- 1 F f1 Prop. Line __510_•- -----•- REPAIR/ADDITION[Prev. Sanitation Permit# --------------------------------------------- } i� .j Date ----------------- Septic Tank {Specify Requirements} -------------------------------- = -------------- _. Disposal Field (Specify Requirements) ------}______________________ ---- -------------- ---1- ----- - (Draw existing and required addition on reverse side) f I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Sta a laws, and Rules and Regulations of the San Joaquin local Health District. Home owner ar licen- sed agents signature certifies the following: 0 I ? "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 becomelsubject to Workrnan's'Compensa#i.on laws of California." ; - I Sign ed --------- � E �..<---------11------------------------ Owner � By - ----------- ---- ----------------------- --------- � ��1 Title --------- ---- [ '(If other than owner) ,� ! l:+.�I FOR DIE SE ONLY APPLICATION ACCEPTED BY -__--_ ___ --+_-- •�� ` BUILDING PERMIT ISSUED -`-" - = G DATE ` � = i DAT -t----- -- -------- A ADDITIONAUCOMMENTS �__•---__- __.--` � a I --- - ------------------------------- ------------ --- ---- - - "} Final Inspection by: ---- - - Date -- , ---- - ------------- ---- ---- --- �-— .-L��....�.-..,..._SAN,yJ..OAQU CAL_.HEALTH_D.ISaT E. H. 9 '1-'68 Rev. 5M �[/r'