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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---------- (Complete in Triplicate] ------- I------------------------------------------ ---- {I'. -----------------------------_-----------__- 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 1 described. This application is-,made in complliian]ce with County Ordinance No. 549 and existing Rules and Regulations-. ADDRESS/LOC AT N,�_f_ Jf r _----_'lf------ ------ - ---- "' -----CENSUS TRACT -5-96----------- Owner'same - -- ---------------------------- ------------------------- ----------Phone ---------------------------------•-- ,Q� 1 r Address d `;''� „zf1 _ City - - Contractor's Name - ---- ---------------License # _� � Phone ------------------------------ Installation will serve: Reside ce [ Apartment House^❑ Commercial :❑Trailer Court ;❑ j jj Motel ❑Other ---------------------------------------- Number of living units:------f____ Number of bedrooms ___:.Garbage Grinder ---------.-- Lot Size _______________________________________ _ Water Supply: Public System and name ------------------------------ ----------------------------------------------------- ----------Private Character of soil to a depth of 3 feet: Sand'❑ Sift E] Clay El Peat El Sandy Loam Clay Loam 0 Hardpan ❑ Adobe,❑ 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.) NEW INSTALLATION: (No septic tank or n seep ge pit permitted i public sewer is available within 200 feet,) ( PACKAGE TREATMENT { ] S1:Plco-o TANK 1Siz ------- ------- Liquid Depth ____ _______________ Capacity -- TYP------ e _ - --- Material__ Ili-e------- No. Compartments s4__________ ____ Distance to nearest: Well ____________ e___i______________Foundation _____kV__0_______ Prop. Line _-_---- No, of Lines �LEACHING LINE ------------- Length of each line-----94-1--------------- Total Length OP4 P-_+....._....__ 'D' Box ---------- Type Filter Material ----- Depth Filter Material --------j_4.11----________________________ Distance to nearest: Well -----SO f--------__- Foundation -1_-__L_p__`_______ Property Line .__- ._f_____________ 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.(Prev. Sanitation Permit# -------- -----}----------------------------- bate --------------------- ------------ i - Septic Tank (Specify Requirements) ----------------------------------------------------------- -----------------.._--------------------------- Disposal Field {Specify Requirements) ----------------------------------------------------- ------------------------------------------------ t �. (Draw 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 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:- e , j-j + "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner i r as to become su . c Workman's Compensation laws of California." Signed - w - - ------ - ------ Owner . BY ---- --�- - --- --- --- ------- Title Y 1p?sir ------- --------------------------------- other than owner] ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - -------- - ----- ----- - -------------- DATE2- 47__" �- -------------- BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE ------ - - -- ------------ -------------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------------ --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- ---- ---------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ----------------- -------- -' `�- -------- cif Final Inspection.by: �� -------- -- ----- -------- -----------------------------------.Date 7-�- --��- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,