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FOR OFFICE USE: APPLICATION FOR SANITATION. PERMIT �p/ Permit _- -.---- i �$ low i (Complete in Triplicate} No. -- - 68 _ Date issued' ___-�J.�.I------------------�I_��- --------=_--__ . � This Permit Expires 1 Year From Date Issued r Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal) the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA? N . -..-� :- -� _ d -- - ----- ENSUS TRACT Owner's Name lC�- R �. Com` r o e - --U ---- i s _ city - �� Address -------- ---- °� 1�---- - -- -- ------ --- - -- - ----- Y - - - - ---------- Contractor's Name r ----- . -----Licenseradler '_3�_�Phone --------------------------- i Installation will serve: Residence ❑ A artment House ❑ Commercial : Court ;❑ f Motel ❑ Other ---- ---- ---------------------------------- Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ---------------_-__.----_---_- Water Supply: Public System and name ------------------- -------------------------------------------------------- -------------------------------Private R d Character of soil to a depth of 3 feet: Sand'[] Silt❑ CI ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ .0- , "x Hardpan ❑ Adobe fifl Fill Material ------------ If yes, type ---------------------------- F 's (Plot plan,, showing size_of,lot,� location of systeml�in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (Nonseptic tank or seepage pit permitted if public sewer is available within 200 fast,) PACKAGE TREATMENT [ ] I SEPTIC TANK'[ ] Size----------------------------------------- Liquid Depth -------------------------- Capacity - ------------------ Type -------------------- Material---------------------- No. Compartments ----- - Distance to nearest: Well ____-_---_--_--___________________Foundafiion ---------------------- Prop: Line --- ------------- LEACHING LINE [ ] : +No. of-Cines ------------------------ Length of each line--------------------- ------ Total Length ------.--------------_..---- 'D' Box .----------- Type Filter Material --------------------Depth Filter Material -------------------------.-..--------------.- 2". Distance�,fa nearest: Well ------------------------ Foundation -.-.-------------------- Property Line. --------------------.... SEEPAGE PIT [ ] Depth - - ------------ --- Diameter ---------------- Number ---------------------------- Rock_Filled Yes ❑ No C1 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distancelt nearest: Well ------------------------------------...-Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ...._ ----------------------------------- Date -------------------------`-------) Septic Tank (Specify Requirements) ------------------ .- -"----------------------------------------------------- # Dis osal Field (Spey Requirements) _ _ wY. --------- .... ------------------y-------- -`�-�_--------- ��-ice"------, • =1!..C---------------- -----------------------�-77- '----------------------- • .. V- x, 3 (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 be a subject to Workman's Compensation laws of California." Signed -- ----- ----- - --`- -------- - ------------------------------------------ Owner BY --------= -- --- --- --- ---------------------------- -Title ---------------------------------- (if other than owner) FOR DEPARTMENT -USE ONLY APPLICATION ACCEPTED BY --------------- ---------------------------//--------------------------------------------- DATE BUILDING PERMIT ISSUED -------------------------------------------------f - DATE A DITIOIb L C M ENTS ---------------------- - --- --`----- --------------- ------=-------------------------. ` a ove±�' 1k� ------------------------------------------------------------ CSAND ------------------------------------------------------------------------------- Q- : ---------------------------------- - ----- - ----------- ------ ---------------------------------------------- ----------- --- - - -- - Final Inspection by Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. ` E. H. 9 1-'68 Rev. 5M