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APPLICATION FOR SANITATION PERMIT - ----- •--- L ,� � � (Complete in Triplicate) *W0 Permit No. - This Permit Expires I Year From Date Issued Date Issued .71.G/7s__.. ---- - -- - ------------ - _- - i ------- - - - --- - i ` 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 qrdinance No. 549 and existing Rules and Regulations: L JOB ADDRESS/LOCATION - �- --(010�------ - --(;r - - - --° -------------CENSUS TRACT -q ----------- Owner's Name ---- ----l!-- --------- - - - - - - PhoneL_.�_�..a---/-moi- - ------ Address -------------- -------.lW-6 -- -- ' - fl` ty ---------------- --------------- - ------ ----------- Contractor's Name------------ uA_.____._. -License #l�' 5�� .. Phone 'Y�'_V52�lYlfJ Installation will serve: Residence XApartment House❑ Commercial)]Trailer Court 0 L _ Motel ❑Other -------------------------------------------- / z � Number of living units- ----- Number of bedrooms .._.?____._Garbage Grinder- - Lot Size 130_4/._7f2.________._ _ Water Supply: Public System and name ------------- -------- -------------- "' _ Private Character of soil to a depth of 3 feet: Sand'El Silt❑ - Clay Ej Peat❑ Sandy Loam ❑ Clay Loam E Hardpan ❑- Adobe Fill-Material,-------------Lf yes, type .______..______.__-_- `i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.-must--be placed on reverse side.) N, NEW INSTALLATION: (No septic tank or seepage piepermitted if public sewer is available within 200 feet,) W LPACKAGE TREATMENT [ ) SEPTIC TANK; I Size __ ------ Liquid Depth ------- Capacity -_. _ ----_.:_. Type .-___ - :-Material __ --------- No. Compartments ----------_ Distance to nearest: Well ..-._---- t ------------ Fotmdation _._ ___._ Prop. Line -------- LEACHING LINE [ ] No. of Lines --------------- ------ Lengthlof each:line.--__-_-._.-___--- ------- Total Length ,------ ----._..___.___ 'D' Box -----------. Type Filter Material..-----------.-------Depth Filter Material -------_-----------.------------ -------- Distance to nearest: Well ______-----___--_ Foundation ___ ---------__._--__ Property Line -__._-_._______.•____ SEEPAGE PIT [ j Depth ..__............... Diameter __- Number ..._._______.____:.__ Rock Filled_-Yes 0 ..-No (] Water Table Depth -----------------------------__---------------Rock Size .--------- ---------------- ` Distance to nearest: Well-=-�,._ ---------- ._-__...Foundation ----------------- -- Prop. Line ----- REPAIR/ADDITION .._ .._.. � 1 REPAIR/ADDITION(Prev. Sanitation Permit#' -_/ ___._"-- ---------------- Date � Septic Tank (Specify Requirements) ... E�{t[rt�cx..�C!' s�-B-'-' 1. 6' ---Disposal Field (Specify Requirements) _-.__ I _- _.-- _ A _ 1---------- -------- - - L - -- - - - ---_ --- -------------------- - --- (Draw existing and required addition on reverse side) I hereby certify that 1 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 thework for which this permit is issued, 1 shall not employ any person in such manner Las to become subject to Workman's Compensation laws of California." Signed ------------:-------------- ------ --- -- - - Owner By---- ----/_t✓� --- '-' ,-o�� Title-- - - -'- - -- - -- --- --- -- ------ L (If ath an owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.__ _ __. .. _. - _ __ DATE .._- _ __ Zc-------------- - -- --` - =--= - - -- -- ------------------- ------ ------------ - - BUILDING PERMIT ISSUED ___.___ -__ DATE __._.-___-.._...__- ADDITIONAL COMMENTS _._..-__ -_ __..._._..__.__,,...�. _ -- - -' --- - ----------- -- - - --- -------------------- ----------'---------- - -----------------'-- ----------- ------------ ----- --- --- --- -- - - - -i- by- - - --- - - - -- - - --------------------- ---- - --------------------- ------- Final Inspection by: -- - -- - ---- ----------------------------- ---------- ---------Date --7 lt1------ J A IN LOCAL HEALTH DISTRICT LE.H. 9 1-'68 Rev. M