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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT —o Permit No. ._....�./, � .:.7y:.�S... .... . .... (Complete in Triplicate) 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 .... . CENSUS TRACT .......................... . .-�1C7.;.�-� ! `' ` --- .. .....CENSUS.. y Owner's Name .... ..................•-----•--............. ....... .... Phone ...... Address _.� ,a'.�Y City .7 � t r, __ - - .....License # Phone Contractor's Name . � ... ..... Installation will serve: Residence j )Apartment House 0 Commercial ❑Trailer Court 0 Motel❑Other _.. . .. ----- Number of living units:_ Number of bedrooms ...� ,••.Garbage Grinder . _ lot Size ...- Water Supply: Public System and name . ... ......__. ----- � �* Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ Hardpan ❑ Adobe M 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 sidel� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) v PACKAGE TREATMENT I I SEPTIC TANKLiquid Depth .....,l , '....-••••-••• Capacity . loao oj Type pT .� ....... Moterial.600e� No. Compartments .-....�.............. ! ' _ Distance to nearest: Well Z1 ••-Foundation�.... , Lf Prop. Line .._. lrt-- LEACHING LINE No. of Lines Length of each line `total Length .. / �--�•• r. 'D' Box -/- Type Filter Materiai . .._...._Depth Filter Material ... ' 4 Pro Line ...._W40-'i Distance to nearest: Well ....._�D......-.... Foundation ... _... .. Property ; SEEPAGE PIT ( }' Depth 92-1 ... .. Diameter ..• Number Rock Filled Yes 9 No Cl Water Table Depth _._.-------9 ---...................•--.Rock Size -----.-- •�..4- ....... Distance to nearest: Well .../.-fJ ?..�.-.----..............Foundation .-.-`dal - ---- Prop. Line ..... a��-•�•-- REPAIR/ADDITION(Prey. Sanitation Permit# ........ --- -------- _ ......... Date -------_-------------------- Septic _-..._..- •--------Septic Tank (Specify Requirements) l�Ud..� i.............. ----- ..................... ....... Disposal Field (Specify Requirements) ......_.-_._10.1••--- ......... - - - • (Draw existing and required addition on reverse sid_.. e) 1 hereby certify that I have prepared this application and that the work will be done in accordant* with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner er licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed . ........................... . Owner _._. .._ .. _.. .. Title gy . - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ` _._ DATE . ` •••- '' BUILDING PERMIT ISSUED .. _ .- . DATE . - ADDITIONAL COMMENTS _ ...._-._. ..-.._.... _.._.. -- ----- _.. --------- ... .. -- ..... 7-0 ........--- Final Inspection by: ..Date ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M