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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .._......�. -_...__-....-•.. ..................... .. Permit No. .al (Complete in Triplicate) ...__._,..---....,.--•--•--�---------------- --------- Date Issued ............................_.........--...._........ This Permit Expires 1 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: JOB ADDRESS/LOCATION .... 6.€,80...No,....Wes•t;• Ln............................:...................CENSUS TRACT ------.... .......... .....Phone 1t•. Owner's Name ....Elbow Room.. ._..�...John--Fer��.) 7-7-50,16................ Address-'-"-.:. . "-. -.-S....0 .. City . S��iT� .. - -------I.......:.......... ....... Contractor's Name .....Blacka +s..3eptLo---Tank-------------- F License # .,?68955. Phone ...-k61-!70.4B-_---- s-d: Installation will serve: Residence ❑Apartment House E] Commercial (3Troiler Court Motel ❑Other ....bar...&..r.es'rarit -. x Number of living units: .B --"--- Number of bedrooms .....-Garbage Grinder ....... .... Lot Size .J_• .,cre........................•- 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 E] Fill Material ............ If yes,type _.......... ................ (Plot plan, showing size of lot,-location-of_system.._in-relation_to_wells,.buildings, etc.-."must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ] SEPTIC TANK( ] Size.--------------------------------------.._...... Liquid Depth ..........-........1...... i f Capacity .. . .... ...... Type -------- Material..----- ----- .-...--. No. Compartments ................. Distance to nearest: Well . . ._ :.........--r_ -------Foundation...._- -.-•.--- •--- Prop. Line .....................� LEACHING LINE [x] No. of Lines 1. ..._. . .. Length-of each line 60.l.._........ Total Length .... - 'D' Box 1. Type Filter Material ..... _'....-Depth Filter Material ...,,T9'.............._.._._.__._......0 — '--Distdnce to nearest: Well ----._b0'--.--------- Foundation 5-0-'-..............—Property-Li". ..40.!_.............� SEEPAGE PIT Depth. . 2.5.' Diameter .------4Pa"_: Number .........----2............. Rock Filled `Yeses] No ❑ , Water Tab .Depth 9� ....Rock Size... 2 =.;.._.... ¢ Distance to nearest Well ..............10-0.........._.....__Foundation ....1.00.'....... Prop. L-e .........fp ;..REPAIR/ADDITION(Prev. Sanitation Permit# " --------------------------- Date -----. ----_..._.------------- Septic Tank (Specify Requirements) ..- ------------------- .---•---•-- ------ ------.---------- ------•--------- _-._....----- ................ Disposal Field (specify Requirements) ..------ 0.`t" each--girl. ---&---(2.)----4, .'.'X2�.'..-P� ts...-.------.'" ..,. ..................:.+ ............ . -------------------- . -- ------ .................. .�_.............. •-• ----� t __ ` (Draw existing and required a 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 performance of the work for which this permit is issued, I shall not employ any person in such manner ; asto become subject to Workman's Compensation laws of California.” Signed a Owner . Title . Con r+ acto-r� -------By .... ...... . (If other than owner) FOR DEPARTMENT USE ONLY —_ APPLICATION ACCEPTED BY ...... .... DATE .. -. ..�S .-.- BUILDING PERMIT ISSUED ....... DATEj- ..._.. .................... ADDITIONALCOMMENTS ............. ....................•--..........--....--•--•--•---•----.....----- -------.....- ------------ ....:.... ......................................................................... ....... - .._ .._................1...........-.........._-..-......-........................................--------------- ............................................ ..... .... __ -.._---- ._---- ....-...-----------:'.---------------..911 .... ....._. Date ..... �Final Insection bG !-.G ? PY --- --- • --- ----• SAN JOAQUIN LOCA HEALTH DISTRICT /`�✓ E. H. 13 24 1-'69 Rev. 5M 7/723X "