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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - '']] , (Complete in Triplicate); Permit No. -- -4, --------------------- t/ I -------- •----------_- , ------ Dalssued .�-'7'- U . ----------------------------------- --------. This,Permit Expires-1 Year From Dateltued` Application is hereby made to the San Joaquin Local Health District fora ,permit t6-Construct and JnstaII the work herein described. This application is made in cpmp)lance with County Ordinance No. 549 and existing Rsles and Regulations: JOB ADDRESS/LOCA;" -- ------ --- - ------ --- ----- CENSUS TRACT --- -------Z-- Owner's Name : f ,. Address , Phone City _ __ _ Phone Contractor's Name --__- .__.License# ��P _ �'�" 7 - --- -- ------ --- -- - --- -- �--- ............. Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court -0 Motel ❑Other ---------------------- Number ---- ---- -Number of livingunits: __-.- Number of bedrooms _____ 41I.-Garbage Grinder _____ ____ Lot S'1'ie Water Supply: Public System and name __ _________ _ _ _____ Private - -- -------- -------------------------------- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay []. Peat❑ SanC)p}�'toam ❑ Hardpan❑ Adobe Fill Material ------------ If yes,type_:_- 2 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reversesicjcf) - NEW INSTALLATION: (No septic tank or see ge pit_,permitted if public sewer is-available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK, 'Z � �ize_�..�-��-----'�-��--r-•- - ----------- Liquid Depth --�1�- �------ --11 ------ �• Capacity JL#p-. .._ Type _04 4` Material__ -,t ...---_ No. Compartments ':r _ ,,/Distance to near t: Well --- r-------_-------------FoLmdation :._-10- ---=___-- Prop. Line----------------------- LEACHING S-—--------_ ^ LEACHING LINE [ No. of Line _--__- ------------- Length of each line-___1-0 -------------- Total Length 0__f { D' Box _--___ Type Filter Material ._ . •1`-,_....Depth Filter Material --- 1 �� Distance to nearest: Well _ _S� f-_._.____ Foundation .....1-� _�;-------- Property Line .._ ._# it j ....... , SEEPA PIT„' [ Depth ______PL___,_ Diameter, -. __.____--. Number -----__04.__�_.___-__• Rock Filled Yes [ No j] Water`Table Depths '�® - Rock Size Distance to nearest: Well ._._........1_ Q_ ____________Foundation ----- Prop. Line .. ............. REPAIR/ADDITION(Prev.Sanitation Permit# --------------- __ _______ _ ___________ Date -------------------------------- Septic Tank (Specify Requirements) --- _----- Disposal Field (Specify Requirements) _ ..___-._- ...___-__ ----- ----- t ---- --------------------------- $ z (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 S, an Jn oaqui County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Home owner ooaqui- sed agents signature certifies the following: t "I certify that in the performance of the work for which thisipermit is issued, I shall not employ any person in srich mannew as to become subject fig''` rkman's Compensation laws,of California.” Signed------------ - Owner - BYTitle - t � - -------- ----- -=- (lf other than owner). FOR DEPARTM NT USE ONLY APPLICATION ACCEPTED BY - - -------- -- - -- ----- -. ATE S�- BUILDING PERMIT .,ISSUED -- --------------- --- •-- -DATE ------------- ------------ ----------- ADDITIONAL COMMENTS -------------- - - --- ------------------------- - ---- Final Inspection by: -- -- ---- --- <--•- •-------.Date � SAN JOAQUIN LOCAL' HEALTH ,DISTRICTK_. E.'H. 9 1-'68 Rev. 5M