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FOR OFFICE USE: w� APPLICATION ;1=0R SANITATION PERMIT (dim plete In Triplicate) Permit No -- �- Date Issued3-4l-_-2-0. ----------------------------------------- --------------- This Permit Expires'l Year From Date Issued 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 Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATION ._f'j�> --------1 < ;�C�_-:' _------- ;/ ' - ;"_CENSUS BRACT __________________________ ' / - = Phone' ----------------------Name ..-- --� � ',r. ie.-------.�,ff- v ------ ----!-.---- -' Address ---- -' C, ' ------.-4,Fe- ----- ------ p ity &:;�?4-�---- ------------------------------•---•-- Contractor's Name . /K Qsr• I :�-y „ ---y__.License # ------ ------- Phone ---------------------•-------- t Installation will serve: Residence X Apartment House❑ Camlmercipl ❑Trailer Court ,❑ Motel F1 Other - ----------i----------- --- ------------ Number of livingunits:.__ f umber of bedrooms '� Garbo a Grinder - _ ---- 3 �. Lot Size -til L`� a��17 Water Supply: Public System and name --------------------------------------------------- ---------------------- --------------------`----------Private ❑ Character of soil-to a depth of 3 feel:t� Sar d'❑ Silt❑ Clay E] Peat E] Sandy iLoam -❑ Clay Loam ;❑ . Hardpan E] Adobe% Fill Material ----•- -------If yets, type ----------- ---------- a* (Plot plan, showing size of lot, location 9 ;system in relation to ells, buildings, ett. must be pl#ced on. reverse side.} I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` F � � PACKAGE TREATMENT [ SEPTIC TANK'+ }+ 1 Size_` }�tc `__2 ._ ___r.__._______ Liquid Depth 41 --____-____,_.... '.Capacity -rA pe"� Material_ _ lj - No. Compartments ___f.............. . Distance fo, nearest: Wel l___=-__----------- -----Fobndatioh"ma-_------------ Prop. Line __a..` LEACHING LINE No. of Cines ------ .______________FLength(of each {+line---5'J-_'--------------- Total Length - ............ 'D' Box "44-- Type Filter Material'l.r, -AL6 Depth Filter Material s_____.____.-.____________________ e� .. Distance to nearest: Well --------------t------- Foundation --s7-*._-V__------- Property Line -__ts' ............... 1 I SEEPAGE PIT �ff Depth __ _, __ -__ Diameter,�,�---__-_ Number -- --------------- ,Rock Filled Yes No i❑ ' Water Table Depth ____ __ ________ Rock Size" Distance to nearest: Well -----------------_p- ---------t4Fobndation __, -------- Prop. Line ----,-`____-_-----_. REPAIR/ADD[TfbN.(Prev. Sanitation Permit,# -------•-------------------------------------;Date ----------------------------------_} � ;Septic Tank {Specify Requirements) ' ' `_--- _____________ j.._ _ _ ___ Disposal Field'(Specify. Requirements) -- ------- --- -- ----- -- --�'}---- - ------' -:- --- ----------------------------- ---------- ------------------------------------------------------ -------------------------------- ---- ------------------ -7------------------------------------------------------------------ (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.'Nam e owner or licen- sed agents signature certifies the following: F k "I certify that in the performance-of the work for which this,permit,-is issued, I shall not emplo* any person in such manner as to become subject to Workman's Compensation laws of California:" ;Signed ------ ------------------- ---- ------ ------ ----------- Owner Title ----------- �' s iBY - - `� . ------------------------ - -- -------- ------------ (If oth' an,owner) � FOR DEPARTMENT USE ONLY �S -APPLICATIONr ACCEPTED BY -------��° _�'�_---_��- - - --- ------------'�----------------------}-;------------------------- DATE ----------art,��•-'7c�--------- iBUILDING PERMIT ISSUED - --------- =- - ------ ------------- -- -- ADDITIONAL COMMENTS __ r_3_____________✓ � -------- -- -------------------------------------------------------------------------------------------------------• - `p' `� =��t �K --------- = f ------------------------------------------------------------ -------------------------- `�`_�'� �f �c-x a ... ------------.-- ----- ----------------------------------------------------------------- c --- -------------------------------------------------------- -=---------------------I- -------- -- Final Inspection by: - ------ 7—Ja ` Date .. SAN JOAQUIN LOCAL HEALTH,,;DISTRICT II r E. H. 9 1-'68 Rev. 5M