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FOR OFFICE USE: I AFC _.._.--. ATION FOR SANITATION PERMIT ------- --------------------- _ _- (Complete in Triplicate) Permit No. _ -.76-4�_.G .................................... -- -----_-----------___________------------ 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 Fescribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA N _17L55 , � C�G� a= C� , ss. CENSUS TRACT . wner's Name _ .L'i 6 —> Phone --- ---- - ddress - - --------� -L' J City ----------- --------- ------- -------•-- ' Contractor's Name ------ ' :' [? License # .f,F,'T.?.9_�—Phone ------------------------------ Fstallation will serve: Residence Apartment House❑ Commercial ❑Trailer Court :F-] = Motel E]Other ------------------ T umber, of living units:..__._✓_.. Number of bedrooms ..___.__Garbage Grinder .... ....... Lot Size ......_.__._..______---------_____________ Vater Supply: Public System and name - (,,r Zrr✓------------ -------------------------------------------- ------- -----------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam �j 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.) JEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ,-iACKAGE TREATMENT [ ] � SEPTIC TAMC j ] Size-------------------------------,---------------- Liquid Depth -------------------------- Capacity ---------- -------- Type ------------ --- -- Material-------- --- No. Compartments -..-..-------- Distance to nearest: Well ------------------------------------Foundation .........------------- Prop. Line ----------- --------- LEACHING LINE [ } Na. of lines ------------------------- Length of each line:........................... Total Length ---------------------.__.._ V 'D' Sox ------------ Type Filter Material __-_______________Depth Filter Material ._._...__._.____.____._____.___-______.__-_ 4 +' Distance to nearest: Well --------------r_______-- Foundation .---- -------------- Property Line --------_---------____-- SEEPAGE PIT [ ; Depth ---------------- Diameter _______________ Number ------------------------- Rock Filled Yes ❑ No ❑ j Water Table Depth ------------------------------------------------Rock Size --------- ------------------------ Distance -- ---------- ------- Distance to nearest: Well _______________________________________Foundation --------- -- -- -. Prop. Line ----- ---------------- I 4iEPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------------------------- -- Date ------------ -------------------- Septic Tank (Specify Requirements) ---------------------------------------- ----------- ----------------------------- Disposal Field (Specify Requirements) ----------------------------------------------7----------------- 1� `- -------- !'.z-S�/f_�C ---------- - t (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health district. Home owner or licen- sed agents signature certifies the following: ! certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner 's to b o subject to Workma Compensation laws of California." Signed ... - ------------ ----- 6)------- ------- ---f �---- --- Owner � - _...- _ _!----- ------------------ Title ..._Yi. -R �3_�1 ._...:. -- --------- -------- i (If other than owner) FOR DEPARTMENT USE ONLY ) UkPILDING PLICATION ACCEPTED BY - .. vz�f ^ _�4---------------------------------------------------------------- DATE7.. .T.. JG' ------------------ PERMITISSUED .-------------------------------- ------------------------------------- ------ -------------------DATE .. ------------ ----------------------- •ADDITIONAL COMMENTS --------------------- ------------------ -----------------------_--- ------ - --------------- .................................................. ---------------------------------------------------•----------------------------------•- �-------------..__..-----.-..-..- ...... -- -- -------------- - ------------------------------------------------------------------ ............ ---- ------ , .. Final Inspection b Date .... �_ P Y SAN �JOAQUIN LOCAL 'HEALTH .DISTRICT F. H..9 1-'68 Rev_ 5M