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FOR OFFICE,USE - APPkATION FOR SANITATION PERMIT - ---- - ---------- _ -------------- I , � -- - (Complete in Triplicate} Permit No. ---------------------------------------------- . ' 'n Date Issued 11"'__d6-dC7 --------------------------------------------------------- This Permit Expires 1' Year From Hate 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: JOB ADDRESS/LOCATION .----�� --------V WT_SC_P!\(-----------i -- ------CENSUS TRACT ---5�-` �--------- Owner's Name -1.1�:k�_`_._ Q_ a�1-1J ---------------- -------------------Phone ------------------------------ Address --------3-0 _VJfl-_TS_Q- ------- ------------------------- City -----M tGA----------------------------------------------------- Contractor's Name -.--Q.-- _---- /t+q�1- ----1.--------------------------License #2LML- ?__ Phone Installation will serve: Residence)<Apartment House❑ Commercial ❑Trailer Court ;❑ • Motel ❑Other--------------------------- ----•-------- Number of living units:.--- ----- Number of bedrooms `3 r _ --_--_Garbage Grinde .:.. Lot Size ------- _x . ----�0-"ems___-_--_-_ 7. - 14 Water Supply: Public System and name ---------------------------------------------- -------------- -------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe,❑w Fill Materialf-IfrC?_ 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 ublic sewer is available within 200 feet,) [ ' PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------ - - --- --- - - ------------------ Liquid Depth -_-._-.__"-___-_.-_______ "'1] Capacity - ----- -------- Type ------- ------------ aterial-------- '------------.. No. Compartments -----------------•---- 0l Distance to nearest: Well_ _________________________ __________Foundation ---------------------- Prop. Line _-..._..___.__..------ LEACHING LINE [ ] No. of Lines ------------------------ Length of ea h line---------------------------- Total Length ------------------- 'D' Box ____r=_.__._ Type Filter Material --------- --------..Depth FiIter,Material -------------"__----.-.__._....._____.____-_ Distance to nearest. Wel) ------------------------ Foundation ------------------------ Property Line SEEPAGE PIT [ ] Depth ------- -_,__--------- Diameter ---------------- umber :--_--.-"_--_--.__-___-____ Rock Filled Yes Q No C] Water Table Depth -------------------------------------- ---------Rock Size ------,------------------------- Distance to nearest: Well ----------------------------- --------Foundation ------ ---------- Prop. Line ___________.____-___-- REPAIR/ADDITION(Prev. Sanitation Permit e# -------------------------------------- ----- Date ---------------------------------) Septic Tank (Specify Requirements) ___-_ _---"---------------_-_--_-__ _ Disposal Field (Specify Requirements) -----bio=--_-:�K_._-_--. '--------TTL T `______.�1-lel __-____________140 Or----------191?D f_77-0_ -----------&F- ------�N- = 2 --- -----=-------------------------------- ------------------- -------------- ----------- : -------------------------------------------- -------- ------------------------------------------------------------------------- ------ (Draw existijag 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 pe rmanc f the work for which is permit is issued, I shall not employ any person in such manner as to bec bj Workm 's Compensation law California." ' Signed '' - -------- ---------- -- Owner 13 --------------- . . Y ------------ -- ---------------------------------------- ----- ----------- Title --------"----- -- - ------ ----------- ---------------------- --- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --._ i- =Q_,_..---- .------- -- - DATE ------- ------ BUILDING PERMIT ISSUED - ----------------------- --------------------------------- =-------- --------DATE ADDITIONAL COMMENTS ------- -- --------------_: --- --- ',= =---•------------------ --------------------------------------- ------- 7----------------------- --------------------------- --- -------- ---------- -- ------------- -- --------------------------- ------------------------- - ✓ ------------------- ------------ ----------------------- -- -------- - ---------------------------------------------------------------Z-- ------------------ --- -------------------------------------- ---- - --- ---- --- ------ -- -- -- -- -- -- -------------- Y. ---------- _ ------------------------------------------------------ -- - Final Ins on b Date -_- _-- ? ....... S, --- -- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT -.-- E. H. 9 1-'68 Rev. 5M