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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ Permit No. - �a- ----------- - -- - (Cemplete in Triplicate) ------------------ Date Issued - This Permit Expires 1 Year From Date Issue 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 madein compliance with County Ordinance No. 549 and existing Rules and Regulations: ADDRESS/LOCATIO D / _---------------------------------------------- JOB - CENSUS TRACT - - - - -- --- --- - - --------- ----Phone ---- ---------------•---------•---- Owner's Name ..-_ - - -- --------- - - Y ------------------------------------ ------ Address ---- -- �M1-•��--- ------- ------- ------------------I �,, Apartment House Commelc als❑Trailer C--------------- Pone ------ ----------------------- c Name - ------- ------ -- - - - --- -- ------ ----- ------------------------------ Court i❑ Installation will serve: Residence Q ❑ ��---- Mo#e! Other --- ----- ---- - ------ - 'x/ /{ Number of living units:----I------ Number of be ours _-------Garbage Grinder ------------ Lot Size _�--�5----------- - ------------------------------ Private ❑ Water Supply: Public System an name --------- -------" --- ------ ---- ---- - - -- Character of soil to a depth of 3 feet: Sand'❑ Silt:❑ Clay ❑ Peat ❑ Sandy Loam ❑ ClayLoam .❑ i �. Adobe Fill Material ------------ If Yes, type ---------------------------- Hardpan ❑ p (Plot plan, showing size of lot, location of system in .relation to wells, buildings, etc. must be placed on reverse side.) w NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is a voilable.within 200 feet,] SEPTIC TANK-[ ] 4 Size_-----__"--- --- - - - ---------- Liquid Depth ------------------------- PACKAGE TREATMENT [ I - ----- Materil---------------------- No. Compartments --------------- ------ Ca acitY ----- ------ - - TYpe ---- ------ Distance to nearest: Well .............- ---------------- ---Foundation ----=----------------- Prop. Line -------------=-------- . -, , ---- Total Length -----------------•---------- LEACHING LINE [ ] No. of Lines __`;------------------ Length of each line-----------.--------- -- ----_Depth Filter Material - -----------••-- i 'p' Box .___-- ----- Type Filter Material ____________ __ Foundation Property Line ---------•--------•-•--- Distance to nearest: Well ______________ _ --------------- Number -__-"--E---,-- Rack Filled Yes ❑ No i❑ SEEPAGE PIT.'.[ } Depth -------------------- Diameter 9 . _ . � Water Table Depth - p. Line ------------- -------- -------------- ------Rock Size ------------ ---------•---•---- ----- ---------------- -------------- Foundation - Pro � Distance.to nearest: We ------------------------ - ------------------- REPAIR/ADDITION(Prev. Sanitation Permit ----- ------------ Date -------------------------•---- ) Septic Tank {Specify Requirements] ---------------------------------------------- . Dispos,al[[ Field (Specify Requirements) ---- -------- .%T.a - « ,�►,p --- ------ --------------------- �' ------------- -------� I ------------------------------------------------ --------- ----------------------------------- ¢ i t - .i (Draw existing and required addition on reverse side) ; I hereby certify that 1 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 in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to beco su I ct jo Wor a s Com nsatlon laws of California." -r C • --------- Owner Signed -" ---------- --------------------- ----- ----------- •------ -------- ----- Title ---- - ----- - --- --- ---- ------ -- -------- --- ------------- {lf other than owner] - - �4t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- ----------------- -"----- DATE --- a-Y - ---------------------------------- --DAT ------- ------- ------ ------------------- BUILDING PERMIT ISSUED ---------------------------------------- -------------------------- ------- --------. ------- ------ ----- ----- ADDITIONAL COMMENTS --------------------------------------- j l - -- VY ---------- ----- ------------------ ---- - - ----------------------------- ---- - 1 - - -- - -- - --- -- --------------------------- Date -_ .. . ----- ------------- Final Inspection by- -- --------- -�---- - - SAN JOA QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.