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FOR OFFICE USE: APPLICATION FOR SANITATION PERMITp ^1 Permit No. ele, A __-____--___"____________________ ___� _______�__�_ ,f f (Complete in Triplicate) K -------- Date Issued -------------------- This Permit Expires 1 Year From 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 {�7.__Cl----�!--_-�r�='------�F?'-�-�-�'I-�:9��z---------- -------------------:----CENSUS TRACT ------------- - -Phone --------------------------------- Owners Name _ Address ......... `'-------------------- --------------------------------------------- City ------ ------- ---------------- Contractor's Name / , / -- �� License Installation will serve: ResidenceA Apartment House❑ Commercial ❑Trailer Court I❑ ' Motel ❑Other ------------------------------------- ` Number of living units:_..-____ Number of bedrooms _ .__--_Garbage Grinder01-:�'-_ Lot Sizer- Number " Water Supply: Public System and name .____------------------------------- - -----------------"""""-""""""'- Private Character of soil to a depth of 3 feet: Sand❑ Silt[:1 Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 121 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 seepage pit permitted if public sewer is available within 200 feet,) r Sz ---------------- Liquid Depth f� SEPTIC TANK ------------- PACKAGE TREATMENT { ] ) e_ , -// TyP _ Material _�/7, �s--- No. Compartments ------ _ Capacity/V, -'- ---- `I---------------- - Foundation _l'7-- ----.- Prop. Line � ��' N Distance to nearest: Well ,�` " _-- . 6 LEACHING LINES No. of Lines ____,47'___-.____-__ Length of each line__. ------- - Total Length r��-------- 'D' BoXeto E`?._ Type Filter Material 46epth Filter Material l0---------- ------- - . .}� Distan nearest: Well -fl�----- --- Foundation _, ,�' -------------- Property j Ine A------- -- SEEPAGE PIT [ Depth _a -��-- ___-- Diameter ______ Number ___. �•c_.___._.____.---- Rock F laed Yes No i[] Water Table Depth ---460�---- ----------------------------Rock - Size ------------- 01 --- ---- ........Prop. ------ S REPAIR/ADDITION(Prev. Sanitation Permil'+#?_"`:~'. .Date _"------ -------- ------------) Septic Tank (Specify Requirements) ----------------------"- ---- ------------------ Disposal Field Field (Specify Requirements) _.-------------- ------------------------------------------------- --------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ - - ----------------------------------- - ----- ---- (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: "I certify that in the performance of the work for which this permit is issu#d, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------------------- --- ----------------A---------- Owner ---- - BY --------------------------------- �--` Title - Jr3 ------------------- ----- ----------- (If othe an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -I �--• - DATE - 01911- 7 ADDITIONAL COMMENTS 1 �s-- l -------0_la,�---- - � Ole- 1 --------- ------------------- BUILDING PERMIT ISSUED --------- ----- - ---- -- - - --- ----- DAT -------------------------- - - - - - ---------- -------------------------------------------------------- ----------------- -- --------- ---------------------------------------------- - ------------=- -------------------------- - - - -- Final Inspection by: --- --- ----- ------------- - --------------------------------•---------------------------------------------------.Date ---//_--.�SF.-----�----�- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M