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,''-'FOR OFFICE USE. . ,PPLICATION FOR SANITATION PE''IT y (Complete in Triplicate) it No. �.. f -Z�� ............................_..--- •- ----- --•---- r This Permit Expires 1 Year From Hata Issued Date Issued .._...`/..7 Application is hereby made to the San Joaquin Local Health District for a permit to cons C laba rk herein described. This application is made in compliance with County Ordinance No. 549 and e n lotions: JOB ADDRESS/LOCATION ........---...7_(Vy _-. tc.t�R�T" ---�A?.:.........................".....C>=NS175 TRACT .................-...__ rf a..&, _ Owner's Name.--_... ...............: A....__ -- Phone �� 1......---•-- Address .................................................. ------ ------------ c- ._. City ..... CKI�@ 3 Contractor's Name �+1_f ��'�s _- �!` ��'''�-------------License # ` 3` ------ Phone _ _ ' Installotion will`serve: Residence{Apartment House C❑ Commercial ❑Trailer Court ❑ Mote( ❑ Other Number of living units;,_(.:r.._ Number of bedrooms :_.._____Garbage Grinder .__-__.__.__ Loi Size . �' ^_ ,` WaterrS�ppwr Pdblic S�stem and name -------------------_- -------• --- Private ❑ s ChQrdcrer-of sail fo a deptf of Veet: Sand D Silt❑ Clay ❑ Peat❑ ' Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe X Fill Material -------- If yes,type ............................ (Prot Man,an, showing size of. lot, location of. system in !'relation to'we(ls, buildings, etc, must be placed on reverse side.) NEWINSTALLATION:!_ s tank or seepage pit etmitted if public sewer`is available within 200 feet. p ..p.. ; p:a,... P ) s.PACKAGE TREATMENT--f �_ IC TANK f ] Size........................... ................... Liquid Depth ...................Capa icty Type . Material_..... -._... No. Compartments ...:.................. z. Distance to nearest: Well ....................................Foundation a�-' . . .............. _.... Prop. Line ...................... .,ACHING LINE. )� ] No. of Lines g C ------------------------ Length of each tine__.............._.:..:,_... Total Length _._.__.._......-----•_---�- 'D' Box ...... Type Filter Material -------------- .Deptiv ,F.ilter Material ...................................... �( Distance to nearest: Well Foundation ....... Property Line ________________________ SEEPAGE PIT [ 1 Depth ____________________ Diameter ................ Nu =:_-__..____...._.. ........ Rock Filled Yes ❑ No Q �. Water Table Depth ._Rock Size � Distance to nearest: Well ........................................Foundation ............__...--- Prop. -Line _......__�...----•-- "REPAIR/ADDITION(Pr . Sanitation'Permit# ______________________ _- Date ____) c an (Specify Requirements) ................. Q- ..-- •- --------:--- k.._-.....................--------------•-----°------.... �.:- Disposal Feld (Specify Requirements) ---------- .......... ............................................................. Y.-._-... .---•------------------------------------•--------- ------. --••-----------........-- •-•--------------•-----•-•---------------•----------•---- `' ' �> ,w i (Draw existing and required addition on reverse side) r Lfiereby certify that,I have prepared this application and that the work will be done in accordance with San Joaquin ,-,C County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health Distriowner or Iican- sed' ct. Home'agents signature certifies the following: L,certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner batome subject to War man's Compensation laws of California." ( Signed _....... _ ... ............................................................... Owner .. ... . _. Title ... f of er than owner) y EPARTMENT USE ONLY APPLICATION ACCEPTED BY7.,&d----. DATE BUILDING PERMIT ISSUED - ....DAT ........................................... ADDITIONAL COMMENTS --------------..............:-------------------------•- ....................... ......................................-__.-_.......... ............. ------------------------------ -------- Final-Inspection by: ....................................-- ------ ...._.. - -- ..........._.. - -..........Date ............................................ SAN JOAOUIN LOCAL HEALTH DISTRICT �i`F H.13'`24 1-'68 Rev. 5M 7/723m