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FOR OFFICE USE: 4 - APPLICATION FOR SANITATION PERMIT ~, (Complete in Triplicate] Permit No: 1�-�- --- -.. ---------------------------------------- --------------------------- This Permit Expires I Year From Date 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: JOB ADDRESS/LOCATION Al----------------------- -I_ -/l------------------ --------.---------------CENSUS TRACT Owner's Name -1-c'0---------- _l r-------------------- -------------------- --Phone 6_31'3_03----- Address ,7 ----- -- �C;-I--rai1------------------------------------------- City ----.- Contractor's Name -------- ------------ --------------- - ------.License # Phone Installation will serve: Residence{Apartment House-[] Commercial ❑Trailer Court ;❑ T Motel [] Other �. r V / Number of living units:.-/-------- Number of bedrooms -2-----Garbage Grinder �-___ Lot Size -_��--.-�-�/� - ---------- Water Supply: Public System and name --� G�-l----- -- -..�.- - �j..^C- ------------- Private ❑ f Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe P Fill Material ------------ If yes, type --------------___-------_-- (Plot plan, showing size of lot, location of system in relation to- wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'[ I Size----- ------ ----- Liquid Depth ----------_--__-_---- Capacity -------------------- Type -------------------- Material-------------------- No. ,,Compartments --------------- Distance to nearest: Well ------------------------------------Foundation -------- ------------- Prop. Line -_------_---__------.- �` LEACHING LINE [ ] No. of Lines -------------- ----___- Length of each line---------------___-.--.--- Total Length- 9 ---------------------------- 'D' -- - •----•----------------'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------- y Distance to nearest: Well ------------------------ Foundation -------------- --------- Property Line SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ---------- -------------. - Distance to nearest: Well ------------------------------------------Foundation -------------------- Prop. Line ---------_-_------ REPAIR/ADDITION(Prev. Sanitation Permit# ---(._V_v___---------------------- Date _(a- 2 -.- -/----) Septic Tank (Specify Requirements) Disposal Field {Specify Requirements) -- -N- - l _!_% ,------Q_1�----- ------kv -- lam ` cll. _oe0 (Draw a(is ing 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 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 - the performance of the work for which this permit is issued, I shall not employ any person in such manner as to becom subject t Workma s ompen do laws of California." Signe Owner. ----- fBy ---------- - --------------------------------- - -------- Title ---------------- - - - ----------------------------------------- (if ot er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _'j__.-_,e, _--- - DATE _-- _---- � 1 _�� - = BUILDING PERMIT ISSUED _ -------------------------- ADDITIONAL COMMENTS -- -------------- - �-------- ---------------------------------------------------------- ------- - ---------------- - ----------------- ---------------------------------------------------------------------------- --------------------------------------- --------------------------- ------ - -- ------- -- - ----------------- --------------------------------------------- Final ----- Inspection by: ------ --------------Date - -- --: - SA JOAQUIN LOCAL HEALTH DISTRICT �� E. H. 9 1-'68 Rev. 5M.