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t 'ro*OR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. q: . - ,SCA�NNF - -------------- - -- ------ This Permit Expires 1 Year From Date Issued a Issued _7.r. ...x.....9 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 �(----------[1-�/f -�"L --- -- - - --. CENSUS TRACT ----.----------------... Owner's Name _..__ . _ ./'4�- ��`,:�-:1rG� ------------- ------ -- .------------- --- -- -- `- -- - Phone -------- -- Address --- - iT = -�- - City Contractor's Name --------------------------License # /�z 'f __ Phone Installation will serve: Residence 1�1 Apartment House❑ Commercial []Trailer Court ;❑ Motel ❑Other Number of living units: _1__. Number of bedrooms .J.-_.__Garbage Grinder yCC: _. Lot Size ------------- Water _-_____.___Water Supply: Public System and name ____..._--------------------_----- / -------Private IR Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam El 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 seepage pit permitted'if public sewer is available within 200 feet,) \ PACKAGE TREATMENT [ ] SEPTIC TANK�j] _ .. _ Liquid Depth .fr ................. Capacity Type//Y�_. ':.C1 Material.�_4 . -7 ----- No. Compartments L__------------ Distance to nearest: Well .. ._____.__._...Foundation Prop. Line ------- LEACHING LINE [T] No. of Lines .... Length of each line ----- Total Length 'D' Box e_!57. Type Filter Materials_! !( Depth Filter Material --------------------- Distance _.__............Distance to nearest: Well ----- Foundation Property Line .-;z .'............. SEEPAGE PIT [ ] Depth - ........ Diameter ----_---------. Number ____ -...... ....._.... Rock Filled Yes ❑ No Water Table Depth ...... -- - --------------Rock Size - -------------- Distance to nearest: Well ---------- ..__.__------------- ----Foundation ------ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------ -___---_. ---------.. Date __-__..__--- --- ----.______._) Septic Tank (Specify Requirements) Disposal 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 issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - - ------------------ --- -- Owner BY -/ n/ r than Title er than o erf —FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ------------- --- -----------------_m_------ DATE . -L. -v6 ----------- BUILDING PERMIT ISSUED ------. _-._..._____DATE ......_------...............__.___----- --------------------------------------------- _ ---------- ADDITIONAL COMMENTS - - --- --- --- ---------- -----.....------------ -----------------------M----- --------------------- --- ------------- ---------------------------------------------- ---- - Final Ins ection b -- - - - -- - - ---------------- -C4t'b` ------- P Y --y�%vN�YYl��1 .. - - --------------------- Date - t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ''