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a EOR OFFICE USE: APPLICATIW FOR SANITATION PERMIT j J_J - d.Permit No. ---------- -� --------- ----- U" (Complete in Triplicate) 4 - 7-- ---- --------- ---- - - Date issued �----�-�-�0- -• ' This Permit Expires t Year From Date Issued inse work herein l Health for a rmit to construct rict described T_hisApplication ishapplierebcat onmade is adean Joaqucomplthe Snlian ecwi h C unttytOrdinan a No. 549 and ex stingnRulestalndhRegulatons. 5 # CENSUS TRACT - ------ 1 r -� ✓ ---R------- --------------- - - -- JOB `ADDRESS/LOCATION ��i -- ,�.� c ' i r --- Phone ----- Owner's'Name ------ _ City __J_64- ----------------------------------- -------------- Address � �. _�f _..PiU�-^-"�---------•- ----------------------i------ Q,��,� `�= License # ----------------- ---- Phone Contractor's Name _--✓°""` ------------------------------------ Installation will serve. ¢ Residence g Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other=------------------------------------------- r ? Garbage Grinder -- Lot Size ----------------- Number of living unit ----. Number of bedrooms?*-- --------- 9 ----••------------------------------------------------------------------ Wafter Supply: Public System and name Private El------------ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ V Clay E] Peat El Sandy Loam ❑ C--C-1--1--- lay Loam ❑ ' Hardpan ❑ Adobe Fill Material . ---------- If yes, type ------------------ . buildings, etc. must be placed on reverse side.) .(Plot plan, showing size of lot, location of system i„n relation to wells, * - i MEW INSTALLATION:"' (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` \� SEPTIC TANK' .64` q x �r Liquid Depth - -----------------.----• �J AGE TREATMENT f ] [q Size-- ------------ Type --------- q P wrt_-- Material--- No. Compartments ---V.---------•--- PA Capacity TYpe !X Distance to nearest: Well _-_77n-----------------------------Foundation o-^------------- Pfop. Line -0 i LEACHING LINE [rte' .No. of Lines -------_--------------- Length of each line--- Q----------- - Total Length ,.SQ---..-------- D' Box _ -- Typo.Filter Material �_(�C-_------ Depth Filter Material --- --------- Distance to nearest: Well -------'----------- Foundation ------ a-- ------ Property Line --- ----- ---- -•--•-- s SEEPAGE PIT [I Depth -_A.'F_--------- Diameter _.-------------- Number ----- ------------ Rock Fiiled Yes f No Water Table Depth -_ Rock Size -------------------------------- ------------------------------ � Distance to nearest: Well ----------------------------- ----------- ------------- ----- Prop. Line ---------- --------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- Date -------------------•--------------) ------------------------ Septic Tank (Specify Requirements) ---_-__- _____ ___________ __ ~ Disposal Field (Specify Requirements) ------------------ ----------------------------------------------- - - ------------- -- - - - - - ---------- ----------- ------------- {Draw..existing and required addition on reverse side) application and that the work will 6e done in accordance with San Joaquin I hereby certify that I have prepared this app County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home.owner or liven- ` 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 as to become subject to Workman's Compensation laws of California." # Signed --------- ------------------------ Owner ----------------- Title ------ -------- -- -- ------------------ --------- - (If other than owner) t FOR DEPARTMENT USE ONLY t. _ -------------------------- DATE --- -----�-.//.------- ---- ----- - APPLICATIONACCEPTED BY ------- ------ --------•---------- --------- ---:--------------------- DATE ------------------------------------------- X.;2 - --- BUILDING PERMIT ISSUED . 1, ---------------------------- -----------------------=------------------------- - - - ----------------------------- ADDITIONAL COMMENTS .-- �� ---------------------------------------------------------------------------------------------------------------------- --- -- - -----------.Date ._.. + - ------ Final inspection by: +.�e s f ------------ -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M~