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¢ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------ • (Complete in Triplicate) Permit No: 2.,.?--_J6__-_. ---------------------------------------------------------- 5 ------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a 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: JOB ADDRESS/LO ION -- -- - -- - TRACT Sq TRACT I ,r Owner's Name 'tea- _ •-----------------Phon� 'k (1�- . City � Address ----------------- - - - - - ---- -•---------•---- .......... Contractor's Name e j---- ----- - -- ---- --- ------------ -= License # IY Phone Installation will serve: Residen a if Apartment House❑ Commercial :❑Trailer Court i❑ I Motel ❑ Other --------------------------••-----<-•-------- Number of living units:------i_---- Number of bedrooms ____Garbage Grinder ------------ Lot Size -- ' Water Supply: Public System and name ----------------------------------------- ..........................................._---........Private Character of soil to a depth of 3 feet: Sand'❑ .Silt fl Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe ❑, .Fill Material ------------ If yes, type ____________________________ (Piot 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 seep a pit permitted if p blit sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size-- _____X__ ___-X-__� ,,.//-- Liquid Depth 7"-- ... I ] Capacity ��^"-�--.---_ Type 6_____---___-Ap�_ Material--r No. Compartments -- --_._._...__•_.. "f Distance to nearest: Well�-------_�Q_P-_.-._�..-.Foundation ---------______-__.Prop. Line ....9__......_ LEACHING LINE [�No. of Lines ---_. _______ Length of each line- }" �16---------______ Total Length -----I.......d1. ....... y` ` 'D' Box ------ Type Filter Material ______ --. _Depth Filter Material ------- 1__________________________,_._- Distance to nearest: Well ` 457 _-°Foundation __�_1Q___.____.__ Property Line -----5. _ . 3SEEPAGE PIT [d� Depth _____ _S_ �------ Number ____- �y s_______-- Rock Filled Yes No p Diameter _______ __ .r< FP _� .. �....- -_l. --kms. .tr-- f Water Table Depth -- --------------- --- '--=-Rock Size --�- --3 r Distance to nearest: Well ------Ian- ............Foundation ---�_____________P op. Line ____�__.____________ i`REPA IRJADDIT[ON(Prev. Sanitation Permit -------------------------------------- bate ____--___._..___._-...__.._..___.-] �tSeptic Tank (Specify Requirements) ------------------------------------•------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ---•------- ------------------------------------------------- - -------------------------------------------------------- ------------ -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- /1) 1 ' (Draw existing and required addition on reverse side) ]'hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 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 Wo m n's Compensation laws of California." Signed --------------------- - -- -- --- - -------------------- Owner B -✓�-r_ - Title Y ----- ---------------- --------------- ---- ------------------------------------------------------ (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------ DATE e 7 J BUILDING PERMIT ISSUED ----- ---------------------------------------------------- -----------------------------------------------DATE ADDITIONALCOMMENTS ---------=---------------------- -------------------- -------- ------ --------------------------------------------------=--------------------------- ---------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------- --- ------------------------------------------------------------------------------------------------------------------------ ----------------------- ------------------------------------------ -------------------- Final Inspection by: ------ }a r Datet�--------- - -- --------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT w E. H. 9 1-'68 Rev. 5M.