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FOR OFFICE USE: , 4 o APPLICATION FOR SANITATION PERMIT -------------- --------------- - •-�- Ss Permit No.-- -r_ L �' /O c3 �'-{-- J '- (Complete in Triplicate) ! ---------- - --- • ------------------------------_---_---------• This Permit Expires 1 Year From Date Issued 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- op--- ---------------- -- --- --CENSUS TRACT --------------•------ ----- JOB ADDRESS/LOCATN --------------- Owner's /Owner's Name --------- - ----------------------------------- - -------- -- --------- Phone---------------------------1,--------- rAddress ------. _ 4 -----------------•------------ ----------------------------------., _ City - # - =- ,PtI7 -------------------------------------- fi Phone � ,iContractor's Name �_�f�------------------------------License ew Installation will serve: Residence; Apartment House❑ Commercial ❑Trailer Court '❑ { Motel ❑ Other -------------------------------------------- p f Number of living units:---1__/-.. Number of bedrooms _-�-----Garbage Grinder % Lot Size O-9� ` _ -� Water Supply: Public System and name C-14 ---------- ---------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ w ; --------------------------- Hardpan ❑` Adobe 'X 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.)e.) �. NEWINSTALLATION: ;No septic tank seepage pit permitted if public sewer is available within 200 feet,) - �» i PACKAGE TREATMENT SEPTIC TANK. S'ze --_ _ _X__'.�-__A_, �----------------- Liquid Depth _7�- ----------------- \' " Capacity ---- Type Material_- No. Compartments - �'/ l f A r 4 x'�Distance to nearest: Well -_�P_' --------------------- -X ____-____-- Prop. Line _/0 x-_- LEACHING LINE No, of Lines --__r_g------------ Length off Bach Imp__.. ` ------ ------ Total Length /- ---- -----......... v r. }D' Box - 1'_-/ T e Filter Material/- ! �,De th Filter Ma Materi Pr Line _-- -._-_ f; ` 1 i Y: ------------ F Foundation - - 0------------- ---=•- -- Distance to nearest: Well � � � Property SEEPAGE PIT Depth -- _ -- Diameter .-_-- Number -----.- --___---_---- Rock Filled Yes No .` Water Table Depth ------------------------------------------------Rock Size ------------------------------- 1 1 Distance to nearest: Well . ------------------------Foundation __ .-_- --- Prop. Line ---_.A-___._- �. . Septic Tank (Specify Re uirem:entsl-7--------------------------------------------------- t -,-;.--T---- ---• ---- - 1 REPAIR/ADDITION(Prev. Sanitation Permit�# -----------------------------------------_ ate _----_- Disposal Field (Specify;Recfuirements) ---------------------------•------------------------------------------9s-----------'--------------------------------•- -' -=-------------- ------- i ------- ------------------------------------------------ __ --------------------------------- l-h--r certif that 1 havei'~r ared this and Ithatth „ ). { g q addition on reverse side) , 'hereby y sp pro pp a work will be done in accordance with San Jodquin ' County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Qjstrict Home owner or licen- sed agents signature certifies the-following: �+ ."1 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 Con%pensation laws of California." 1 f Signed ---------- --- ----------------- - --------------------------------- Owner ' _. ------------ Title ---, y ------------------------ ; -- -- --may ----- - (If r hon o ner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .------ }--------------------------------------------------------- DATE CI -2? 6-g-•--- BUILDING PERMIT ISSUED --------------------------------- - -- ------------------------------------------=--------------DATE -------------•------------- i --- -- ----- ADDITIONAL COMMENTS ----------------- ---------------------------------------------- --- -- ------- --------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- -- ------ . Final inspection by ' 8'__W_v -a------------- ----------------------------------------------- --------------- Date Z ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. �`° • `k° +