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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �} ----------------------r ----------------------- Permit No. (Complete in Triplicate) ,. �. ---------- ---------------------------------------------------------- -------------_--------- ------------------------.--------- This Permit Expires 1 Year From bate Issued 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: �}o w Of r�l JOB ADDRESS/LOCATION - --- ---------------CENSUS TRACT ---------------•---------- Owner's Name _ 1. / 'L -------------------- - - ----Phone �1_-A/ Address ------ __11116�--------1C- -___*�L- ------a~_.__moi''-../eaZa------- City . - --- ------------------------------------- Contractor's Name ------C -------- ------- -------------- -- ------------- r =-.License ---- Phone I Installation will serve: Residence j 1 Apartment!Hause,o Commercial ❑Trailer Court ;{] Motel ❑'Other -------------------------------------------- Number of living units:____._ ____. Number of berooms ___ ______Garbage Grinder ------------ Lot Size ________________ = cJ a i Water Supply: Public System and name -__-- h— <rG_-----------------------------------------------------------------------------------Private ❑ Character of soil to a depth of,3 feet: Sando' Silto Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam :❑ Hardpan ❑ Adobe"❑ Fill Material ------------ If yes,tyke---------------------------- (Plot yke_____._-________________(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 sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANKSize -- -----'�-�'--%�'.lQ----- -------------=-- -------- Liquid Depth ---_`5-----. Q Capd6ty/.Z00'_64V Type ._ . Compartments ..c;Z-............... W Distance to nearest: Well _____��-r r----------------------Foundation --f�------------ Prop. Line ------- ........ LEACHING LINE J' No, of Lines ----e2r____---------- Length of each line--------els—_1-------- Total Length _ ®,_ --_---- D' Box --- -------- Type Filter Material -/L ______Depth Filter Material __1---:-------------------------- l sDistance to nearest: Well __-_ _ ___------� Foundation ------1 Q_ _________ Property Line ---- rf.__..---- tSLEPAGEa* Depth Diameter _X�B___ Number ------.1------------------ Rock Filled Yes E' No "Water Table Depth ------------------------------------Rock Size _.ca -_f-----_______________ Distance to nearest: Well _.,fie _r______________________Foundation Prop. Line -------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ______________---___-_____________) Septic Tank (Specify Requirements) _.---------------------------------------- = - ----- Disposal. Field (Specify Requirements) -------------------------------------------------- T = . . ---------------------------------------- - ----------------------------- --------------------------------- --------------------------------- ------------------- --------•- (Draw existing and required addition on reverse side) I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin i- County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: i "I certify that in the performance of the wof for which this permit is issued, I shalt not employ any person in such manner I :as to become subject to Workman's CompeAction laws of California." { Signed ------------------ -------------------------- ----------- Owner By --------------- �- -------------- -. Title -- (If other than owner) _ FOR DEPARTMENT,USE ONLY APPLICATION ACCEPTED BY~. -------------- --------------------------------------- -------- DATE -- - - - -------------------------- BUILDING PERMIT ISSUED -------------------- ADDITIONAL COMMENTS ----` �_ - DATE ---------------- --- ----- ,` . I ---------------- - --------- --------------------------------------------------------------- ---------------------' ---------------------------------------------------- ----- ----- ----- = ------------ ------ -------------------------------------------------------------------------- - ------------------- ----------------------------- ---- --------------- ti • ----- ..Final Inspection b - ------ ---- - ---- -- ---------- -- --- ------ - -------- - - ---Date -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev,,,5M •- u—