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FOR"'OFFICE USE: - - �^ IPPLICATION FOR SANITATION PERMIT ----- ---- --f f'c Permit No. (Complete in Triplicate) ,V-1A '- Date Issued ___.1�-1 Z__ ? 2- ---- __ ___ This Permit Expires 1 Year From Date Issued lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is I compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------1Q_9 ------CENSUS TRACT -------------------------- Owner's Name ----------------------------------------------------�------------------Phone -----__11_K1...----- Address ------ ------------------------------ ------------------------------------------------- City .......................................... Contractor's Name c.j_,�_�___----------------------License # ___ Phone : Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:----- ----- Number ofA_/c1___ _ rbage Grinder Lot Size __ ,4'_-----":-___..___ l Water Supply: Public System and name:,.--)--- ----------- -- - PrivateA Character of soil to a depth of 3 feet: Sand' Silt C at❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ o r ----------- If yes,type ---------------------------- (Plot plan, showing size of lot, loc tion syste n r on t ells, buildings, etc. must be placed on reverse side:, NEW INSTALLATION: (No septic if blic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTI T - ___ _ --------- Liquid Depth ---�................. it ___ ' _ ! MateriaV0'01eNo. Compartments __?------------------ t n -- ---------------------Foundation ------------ Prop. Line -5...--------- LEACHING LINE ____ _________ gth of each line_______1Q_�___.____ Total Length ----- - 1 'D' T Filter Material _ L ____Depth Filter Material ___-111FO'l--___--__------------------- Dist st: Well ____ _ _ Foundation r ---�-- ��- --J�--------------- Property Line. ---.�----•-----•----- SEEPAGE PIT Depth Diametef .�� _..____ Number ________I__________________ Rock Filled Yes ZFr No C1 , Water T Depth __ .1' ------------------------------------Rock SizeCj ✓�----•---•-•------ i Distance to nearest: Well __/0 _l____________________ .....Foundation ___/Q_�__ __.____ Prop. Line 31. ............ REPAIR/ADDITION(Prev. Sanitation Permit# __.-----------------------------------,----- Date .................................. SepticTank (Specify Requirements) ------------------------------I-----•-•----------------------•--------------------- -----------_-- -------------..----------------------._-•• ' DisposalField (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 issued, I shall not employ any person in such manner as to become subject to W rkman'smpensation laws of California." Signed - --------- -- - =------------------------------ Owner BY ---------------------- --- -- ------- --- - -- - ------- -- ---- ------------------- ----- Title - --------------------------------------------------------- er th er) EPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - ---- -- -- -- ---------------------------------------------------------- DATE ------I� z -z-._----- BUILDINGPERMIT ISSUED ------- - ' ---- ---- --- -------------------------------------------------------------DATE ------------------------------------------- ADDITIONAt COMM NTS -------- --- -- --- ---- ---- ---------------- K 2--------- -r-`---- �" Teo- I- ---� " W� , Final InspectionbY -- Date --------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M