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SCE - ..F OR- FIUSE: �- r << APPLICATION FOR SANITATION PERMIT - Permit No,. --L-�-`--� •- � (Complete in Triplicate) {J� A --------------------------- This Permit Expires 1 Year From Date Issued Date Issued j Application is hereby made to the San Joaquin Local Health District for d per 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 . d` . A (a - --------------- --- -.-- --CENSUS TRACT ---------------------- Owner's Name � ��A/ --�--------- ----------------------------------------------- `----- ---Phone -------------- - / �� - City ! I Address Contractor's Name ---- _ - ------------------------------- License #�It'- - -- Phone ' -- Installation will serve: Residence Apartment House Q-Commerdal;❑Trailet Court :E:]. Motel ❑ Other -------------------------------=------------- Number ------Number of living units:.../__---- Number of bedrooms , F_____Garbage Grinder"�%O'__ Lot Size. ' �� ------------------- Water Supply: Public System and name ------------------------------------ -------------------------11----------'------------ ----------------------Private Character of soil to a depth of 3 feet: Sand'[]' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted-if public fewer is available within 200 feet,) i O SEPTIC TANK' Size-_ quid Depth __ PACKAGE TREATMENT ( ] --�-,�i'¢�`" - --- Li p ��---------.----- � - -- --- - -- -------------- --- T e Material_ No. Com artments -� _-_____:..__ Capacity 2 Yp %" " - p Distance to nearest: Well'____________!_`Foundation,__,2e-________ Prop. Line __ LEACHING LINE No. of Lines ----- -------------- Length_of_ ga - line ___ _______.__.__ Total Length7-1-/ --__�-��w_ D' Box` _ � Type Filter Materiae___� epth Filter Material _ _____________________v_________ v1. - _ Distan -t: nearest: Well �______.Foundation Y i `-� " t9:`------------- Property Line -Xe----•--------- P SEEPAGE PIT (yj Depth A�Z-q---______ Diameter __- Number .......�'______________ Rock Filled YesX No 0 fps � �i.�...,� .._.-,..�.- �' _ Water Table Depth t� : -,-------•-----------------•---Rock.Size.--^- -------------- Distance tonearest:Well ___ / ____________________Foundation e Prop. Line ..�4- _ .____. t REPAIR/ADDITION(Prev. Sanitation'�Permit# _________________ __________________________ Date _____--__-._______________________) ` Septic Tank (Specify Requirements) _ ___ Disposal Field (Specify Requirements) ----------1,/1� ---5 ---_-------------'----- --- 9----'-`---------- ---- ------•--------------- a --------------------`------------------------------- --------------- ------------------------------------------- --------------------- ------r = `,----------• ----- k '% '` I �, ------------------------------------ �- -------------- I(Draw existlng and requiredaddition on reverse side) I hereby certifythatI have pa erredfths application and thata /•�, work will be 4one in accordance ,with San Joaquin County Ordinances, State Laws, and Rules artd Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 1 - f "I certify that in the performance of 'the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensu' on laws of California." •� Signed ---- --------------------- ------------ ------ ------ --------------------- 1`-------- Owner f -„�- Title �ll®°L<T f -------------------------------- -------------- (If�ot an owner 4f F ARTMENT USE ONLY APPLICATION ACCEPTED BY ------ -------- I DATE - --��-��----- ----- BUILDING PERMIT ISSUED ------ ----- ----- ------------------- ------------ DATE ------------- ------------------------ ADDITIONAL COMMENTS -'i - ------- -------------------- --------------------------- ---------------------------------------------------------------- ;f ------------------------------------------- --- --------- ------------------------------------------------------------------------------------------------------- ------------- ------------ -- -------------------------------- ------------ --- -------- ---------------- ----------------------------------------- ---------- Final Inspection by: 4 -� �� Date . -. 2 �_ SAN JOA UM'LOCAL HEALTH DISTRICT d -E.H. 9 1-'68 Rev. 5M .. . i �"C•A_ :'., '