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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ..�. -•--M� (Complete in Triplicate ._._.-.�.._._ ...................... P Date Issued -1�. This Permit Expires 1 Year From Date Issued �~ Application is hereby made M the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ispmaryde in compliance with County Ordinance No. 5/49 and existi�^�L Rule Jand RegulaNenu JOBADDRESSAOCA/TTII�ON J✓LP-l-©Q._.-,-•--..aL.`...yt.� / Jay W. /`�l Pi CENS9 T .......-------------- JOB Name ......4 •" � Phone.............................- 0 ,�� / Address --�O-M-�......�a.._ ,p. - .,�.�.�... - -City Contractor's ame.... Q =I-- -�•l7 �i/E" .Limnse #t��r�.... �_ .ATa'� Installation will serve: Residence UR4(�artment House❑Commercial[]Trailer Court fl • Motel ❑Other ... Number of living units:.../.... Number of bedrooms -.Y Garbage Grinder ,rt/O.. Lot Size Q40*1LdF,�11 -.......... Water Supply: Public System and name ....................•---------•-•---•-------..........._.......-_. --------_..............Private Character of soil to a depth of 3 feet: Sand❑ SIN Q Clay []• Peat❑ Sandy Loam [] Clay Loam 01 Hardpan;K Adobe O 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.) \ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / p� �- i -- ..� -. PACKAGE TREATMENT [ ] SEPTIC/T�ANK 04Size _ Q IV, Liquid Depth ------- . -- `�- Capacity �.r.��i-.f.__. Type' - Material4&.0Ze%4e.... No. Compartments ---- ......_..-. �c- . Foundation -/40 Prop. Line -._-' �;..--- Distance to nearest: Well ... +i - - ----- ----� � s LEACHING LINE No. of Lines ..._ length of each line../E�� Total Length _Z.f�tl:l_ -- - - Q �/� fl 'D' BoxX4tr5 Type Filter Material`�y/�J7[� -Depth Filter Material /4r-M--- ------- i .� Distance to nearest: Well ...qQ ......... .. Foundation ..f.('/---..__..... Property Una .---..._._.._ .-_.. 't �-i SEEPAGE PIT Depth -ya.r --- Diameter _ + ----. Number -__-..---------_----N. Rock Fitted Yes Na C7 Rode Size Water Table Depth _...--- ------ .4 " Distance to nearest: Well __.ZZA _.---Foundation .-..7,&------ Prop. Line .-._--.--r ....--- REPAIR/ADDITION(Prey. Sanitation Permit yit ......_..._.._-........---.....-.... Date _......... -1 Septic Tank (Specify Requirements) - ._......___......._._.._._.�•-------------------- ------- ------ Disposal Field (specify Requirements) --.-__--'-_-_._—.___.._..._._..___...-_-...._..__...._-......_..._._...-___.--. _. ..... ..------.__...---_._._..-------- - - ... - --_.....................-•-----.........---------• --------- ----•-___----------------------------------- - -- (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 whleh this permit is issued, 1 shall net employ any person in such manner as to become subject to Workman's Camp ation laws of Callfomia:' Signed .. ...-- --`--- ------ -' --- - ....... Owner -------------- (1 er than owner) _FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE tL -.��---------•-•--•-•- BUILDING PERMIT ISSUED -_-- - - - ----`-------- ADDITIONAL COMMENTS -------------------•----------•---------.-__---•----....-----------------------...--•------^--......__..............._.._...... ._. -----••--......•.. -.._ ... --------•----.... _. ..... - -._... --•------.-_-._._._.........- ------ ----- --....._-------------_._.__ _ ....._...... ...__..._._. ....- -------------------. _.-....__._.- ---._........ -_ .. -- - - ---- .....- ... o i;----------- - Flnal Inapedion by: ... . -- •-�-- SAN JOAQUM LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM