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-�. FOR OFFICE USE: f -- �- ---------------------=--------- APPLICATION FOR SANITATION PERMIT ----------- (Complete in Triplicate) Permit No. ' --- --------------_------------- �I; ;r 1 'This Permit Expires ] Year From bate Issued —Date Issued Application is-hereby made to the San Joaquin Local Health District for a permit to construct described. This appliratian is made in compliance with County Ordinance No. it t and strutexistingRule and install. the work herein JOB ADDRESS/LOCATION /®_ sand Regulations: 4. Owner's Name ------- ------_--- -------------------- ----- ----CENSUS TRACT f1 l?7 • Address �� --------------------------------------------------------------- ----------------- - i '. �-r-------- Phone ----- ' Contractor's Name- -__ ---------•- • City ' ------ ------ -19 Installation will.serve: License #,/��- gA.Phone I Residence Apartment House,0 Commercial;❑Trailer Court ;❑ } Mote! J. ❑Other -------------------------------------------- Number of living units:-__ _-_ Number of bedrooms ' _3-----Garbage Grinder _ - _- ! Water Supply, public Syst em and name Lot Size Character of soil to a dept. of 3 feet: Sand' �� -- -- ---------Private � Q Si1t:Q Clay Q peat Q Sandy Loam Hardpan ❑ Clay Loam 0 ard P ❑ Adobe)e Fill Material ------------ Ifes Y tyle . --------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be laced NEW INSTALLATION: (N septic tank or see a e P on reverse side.} PACKAGE TREATMENT P g Pit permitted if public sewer is available within 200 feet,) [ ]� SEPTIC TANK ' Capacity � -------- ------ Liquid Depth P Y��A>� TYP � __ r ` e MatericrlC4------ Ir �� .No. Compartments _.� - _ t Distance to nearest: Well --_ e �.._.__ LEACHING LINEI '0' LEACHING __I�----------- Prop. Line ----- No. __ v � of Lines _. --_--------- Length of each 'line. -Ar ---- Total Len Type Filter Material _ _�epth Filter Material Distance to nearest: Wel! _,��0 / � -`-- --' th 7_ Foundation t SEEPAGE PITv F Property Line ----- Dep = Diameter 2 ! No->D Number -__-Z--------_ Rock Filled Yes Water Table DepthNt ------------------------------Rock Size 4_f f ,�'� Distance to nearest: WeJI -_ ®� ------ " REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------- ----------------- Foundation P�----------- Prop. Line ------- ........ Septic Tank (Specify Re uirements Date _- Disposal Field (Specify Requirements} --------------- ------------------ ----------------------------------------------- ---------------------------------------------------------------------------------------- a ----------------------- -------------- J ------------------------------------- ------------- aw existing.and existing and required addition on reverse side) ------------------=------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San County Ordinances, State haws, and Rules and Regulations of the San Joaquin Local Health:District. Home own Joaquin 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 or licen- sed to become subject to Workman's Compensa ' n laws of California. 1` p n such manner Signed �I [.. oth BY n ow1�F ---- -------------------------- Owner Title ---- -- (if -- --7-- -------------- FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ e BUILDING PER}rUiIT ISSUED ADDITIONAL MMENTS - !�:_ ------- - --------------DATE ' C �6� - - -- - DATE ------------------- ---------- - ---- - ,_ -- - __ ------- ---------- ------- ----------------------------- - - mal Inspection by: _ -- ---- { _________ ____________ __ _ - ----•�- ----- ---- --•- ----- ----- ----- --.Date ----�-- ------�-- -- - - ' SAN JOAQUIN LOCAL HEALTH DISTRICT _ E. H. 9 1-'68 Rev. 5M