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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ------------------------------------------ -------- 1 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 described. This application is made incompliance with County Ord.inanceNo. 549 and existing Rules and Regulations: JO`B'ADDRESS/LOCATION-_/�/--___;�_s---._ _ -----------------' ' ..CENSUS TRACT -------------------------- ---- ---- --------------- -- - - -- rp Owner's Name `- ')_ .or ---------------------------------------- -------------------------------------- --------Phone 1 Address G"1�!1 --------------------------------------- City Contractor's Name .__ ----_--_--.__---`� r �� . '� --- - ------License # .--------:�'.------- Phone Installation will will serve: - Residence Ef] Apartment House[] Commercial :❑Trailer Court ',❑ Motel ❑ Other --------------------------------------------- Number ------------------------------------- ----Number of living units:---- ------ Number of bedrooms ____ ___-Garbage Grinder ---_--__--__ Lot Size _.C�d __ J_ /G_U_ _ P Water Supply: Public System and name _______________________________ 6 ------------Private ❑ Character of soil to a depth of 3 feet: Sand`❑ Silt f] Clay .❑ eat❑ Sandy Loam •❑ Clay Loam ❑ 1 Hardpan ❑ Adobe ft Fill Ma#erial'_--.' -- If yes, type ---------------------------- (Phot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) -INEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ------------------------------ Liquid De - . I [ 7 SEPTIC TANK'j ] Size__________________ Depth ---- --------------------_ q p Capacity - ------------- Type ::_ = ----. -Material-__:_ _= `-- No. Compartments -------------_- Distance to nearest: Well ------------------------------------ Foundation ------LL---------- ---- Prop. Line --____-� LEACHING LINE No. o{ Lines U0 ---------/----------- Length of each line_3�_-_�-- j- -�._ _.Total U th _--- ``- - f' 1 / ( _r D' Box ---__- _-- Type Filter,Material r-,__----0-= ------Depth Filter Material -------------------------------------------- Distance ------------ ---------------------------Distance tolnearest: Well -------- Foundation 4 FProperty Line (J SAe "PIT [ ] Depth ---A 0.______ _ _ �L1, ___ Diameter _ 2_- &Wiber ._____._____r___________ Rock Filled Yes EF, No C] G j -------------- �r Water Table Depth --------------------��:------- --- •- --Rock Size ----------c-'-'------------------- r .. ,r- L f . Distance to nearest: Well __________--�--___ _----------Foundation.•__'�Q_------- Prop. Line ____�4_- --_-- REPAI!I ADDIT rev. Sanitation Permit# __-------------------------- - ---------_=Date.=___---_--:--- ------.-1 . 1 Septic Tank (Specify Requirements) ------------------ --- ------ -- ---- -------------------------- -/Disposal Field (Specify Requirements) __________ _r_ __------------------- -' --------- ---------------- /�!G__j_L - _ --- ---------- ------------------°-----=---=--------------------------------------------------------------------------------------------- (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 Loral Wealth 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 as to become subject to Workman's Compensation laws of California." Signed ---------------------------- --------------.�------------- --------------------------------- Owner BY -------- - --------------------------- Title ------ (if other than owner) f TR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ - --- -------------------------- - -------------. DATE __r -/5-7�------------- BUiLD.ING_PERMIT. ISSUED.--- --- --- ----- -- -- --- DATE --------------- ADDITIONAL COMMENTS _-- _ -- - ----------------------------------------- ----------------------- ---- --------------------- ----------------------------------------------------------------------------------------- •--------- -- ----� - -��------------------------------------ ----------------------------- - --- ------- -------- ---- -- --------------------------- - - -- -- ------------- ------------- - -- Final Inspection by: ---------------------------------------- -----------------Date L '1.5=7 SAN J AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M +