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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a Permit o. __._ [Complete in ?v Date Issued _ This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District1for a permit to construct and instaaind Regulations: work herein App Y described. This application is made in compliance with County Or ance,No. 549 and existing Rules g ations: --CENSUS TRACT ----------- JOB ADDRESS/LOCATIO r p- ----------•-- • / ' - . ---------r- r----------------------------------------------- Owner's NameG -- _ ------. city -- - - -- -- - -- - - --- - ----- Address -------------- r_ +� 7- ------------------- 1" , ----------License # j 2�aone __ Contractor's Name ---- :- � 4 Installation will serve: ResidenceJr(}f�jl/Apartment House^❑ Commercial ❑Trailer Court 0 / a 7. j ` I Motel ❑Other -------- - - ---- -- k ` - _Y_______________ Number of living units:--- Number of oo s,___ arba a Gri er ------------ Lot Size " - - -� ,i ` Private ❑ Water Supply: Public System and nameg -- -- ------ Character of soil to a depth of 3 feet: Snd ❑' ilt❑ Clay a Peat❑ Sandy Loam.❑` Clay Loam a .r•H Hardpan ED Adobe Fill Material .-----"-_--- If yes,type ------------------------ (Plot pian, 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 sewer is'availabie within 200 feet,) 5EPTiC TANK; Size------------------------------------ --------- Liquid Depth .- - \ PACKAGE TREATMENT [ 7 [ ] ------- Material------------ --- --- No. Compartments. E---------------- Capacity --- ------------ ��-'-- TYPe�--------- - . k � Distance to nearest: Well ----- ---- - Foundation -------------"---- Prop. Line --------------- ------ LEACHING LINE [" ] No. of Vries ---------------------- Length of each line__-- "------ ------------"Total Length -------------- •D' Bpi ----------- Type Filter2Material___:-----_--------=Depth- �Fi'lter-.M ateri`a1_`... ... i` # I .I� ----------.---- Distance to nearest: Well�-------------------- --- Foundation --------------------- P tY k _ Rock Filled Yes--- No -f❑ I SEEPAGE PIT [ } Depth Diameter ---------------- Number ------•----------------- ---------------- -- _ Water Table Depth ----- ----------------------------- -----Rock Size ------------------------r �_. ,.�.,.- ----n 6 --n t Pro Line ._..IM f-,-"Distance fo n arest:lWefl --------- -----------------------------Foundation P i ) i REPAIR/ADDITION(Prev. Sanitation Permit�# """"-------------------- ------------------ Date ------------------------ ------------- -------- ----------------- Septic Tank (Specify Requiremen#s) __------------------ - ; Ie Disposal Field (Specify, Requirements) �i O ,r, I = = ----------------------------------- --------------------------------- fl f C :- ------------------------------ ------- T --------- _ (Draw existing and required addition on reverse side) I hereby certify. than I have prepared this application and that the work will be done �n 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 a6y person in such manner as to become subject to.Workman's Compeinsation laws of California." I " 'Signed -- ------ -, --------.----------------------------------- Owner Title �sl J' �/------'--- ------ By I other than owner), FOR .DEPARTMENT USE ONLY '� -----Twr---- APPLICATION ACCEPTED BY -.__f___' _ DATE -- __._----� - BUILDING PERMIT ISSUED -- ------------ ----- DATE ADDITIONAL COMMENTS _ --- --- -----------------------------J - -------------------- -- ------------ -------------------------------- '--.---- ----------- _. , Final Inspection b -gate I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.