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..... ........ Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT 4 E. H. 9 1-'68 Rev. 5M Permit No. 7.••••-Z?./.. • Date Issued 27-245 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) This Permit Expires I Year From Date Issued Application is hereby made to the Son 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: JOB ADDRESS/LOCATION Y41-5.0 e ... . CENSUS TRACT __ . ............. , €04_,,..c.:ze 1 Owner's Name Address eQ. 3 / ..............,..R....... City Contractor's Name .cA „License # igt3 Phone Installation will serve: Residence Apartment House El Commercial [-Trailer Court 0 i 4.. i . Motel ri Other . - . .. . : .............. ....:-__•_, Number of living units: ..,.._. NOmber of bedrooms Garbage Grinder Lot Size .: -.. .---- , . (Plot plan, showing size of , location of system in relation to wells, buildingi, etc• must be placed on reverse side.) _ • , i' • NEW INSTALLATION: INo septic tank or seepage pit permitted if Public sewer is available within 200 feet,) , , __Size.- , ..., Liquid Depth ....•....., .....-__•• . Capacity Type -..' Material. : . No. Compartments L., Distance to nearest: "Well Foundation Prop Line J -, _ . L.) ' EACH1NG LINE f] No. of Lines Length of each line 1 Total Length .',..D' Box ••••-• .,...Type Filter Material . Depth Filter 'Material .."--• . 4. _ --,_ . _ • Foundation ....... Property Line, - - ..) i • Distance, to riecti:est: Well - SEEPAGE PIT [ I • Depth Diameter Numbe• Rock Filled yes 0 No ID -t. - Water Table iDepth ' ,. . Rock Size , . Prop Line Distance to nearest: Well . Foundation REPAIR/ADDITION (Prey. Sanitation Permit # - - * '- Date } Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) . I:,-J-e.-0,et...e...... .....40-40.:e 94- /0_ " )( 2_ S-- i (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 i .0 performance of the work for which this permit is issued, I shall not employ any person in such rvtanner as to become u,d. t to Workman's Co firm laws of California." Phone Water Supply; Public System and name . _ ....... .• Character of soil to a depth of 3 feet: Sand 0 /Silt 0 Clay E Peat Sandy Loom Clay Loam Hardpan ri Adobe 1- I Fill Material if yes, type • ..... • . _Private ....... " - • PACKAGE TREATMENT , ] SEPTIC TANK I Signed By...... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BV(2.-C,Z-ei-tel-4 DATE BUILDING PERMIT ISSUED .... , ,, DATE ADDITIONAL COMMENTS ...... . ......... • .... .... . ... ~ ... .. Owner Title