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FOR OFFICE USE: -- APPLICATION FOR SANITATION AMIT - -- ---- -- -- Permit No. -- ------------ (Complete in Triplicate) ,' '�)_ __ This Permit Expires 1 Year From Date Issued Date Issued ___ _:_I�-4'7l 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 _C-_!`_ tc! � A�f G ____--_______-_________-__CENSUS TRACT _____________---_.-.. _ Owner's Name ____. o_e----- ,/�� 1Y�1'!� -------Phone 7_'r� _'_Q �------ Address --------------- ----- ----- Contractor's Name ------------------ --r -----------------------------------------.License # ------------------------ Phone -------------------•--_ ----_ Installation will serve: Residence ❑Apartment ou a,❑ Commercial ❑Trailer Court ;❑ dN Motel�Other _ d_ nr � Number of living units:______ ____ Number of be ooms _'�_______Garbage Grinder _—"_____ Lot Size ___�� -�_____________ f�l Water Supply: Public arl Syste and name -_--- '� ___� S_'J ____._____________________________________Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Q Peat k Sandy Loam ❑ Clay Loam ❑ 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.) 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) . PACKAGE TREATMENT [ ] SEPTIC TANK Size------------------------ _____ _ __ __ _ _ Liquid Depth __________.___..____.__. 1,9,44y).� Capacity t�J--------6-A---__-`__ Type _________________�_ Materiatf,41e N�o..gCoommpartments -- wGll�i� Distance._to nearest: Well ___ ._ ('•_____________Foundation _�(�`_��'__:/____ Prop ne ___ LEACHING LINE jj�J No. of Lines -----------1----------- Length of each line- _-�� i — - D - - W� --LL -------- ------ Total ----------------�--� 'D' Box ___-_I--___ Type Filter Materialri-4 a.Depth Filter Material ____:_____ _______________________ �� , Distance to nearest: Well Foundation _-_fb _ f'____ Property Line ----- .'- SEE GE PIT Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ 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 Re irements /"__ `t_ �� _ �� ^ J" _Tlt /l. _y'�'t� G _ __JJ ---- ----�1 ®M------ �° ----------�Ad .-�__ f --------------- ----�-- ----- 'Q ('_ - ----------- -- ------ _ (Draw existing` n re d 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 Regutations 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 Title`�f "'�'`'� ----------------------- (If other than owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- -------____-- DATE ---------- 4__'�1-______-__-- ----------------------------- --------- BUILDING PERMIT ISSUED _________________ ______ _________ _ _ _ _ ADDITIONAL COMMENTS __s__�1 7 --" -- - - __ ore t�k---------------- - ------------------------ --------------------- tom-- -- - -_- r�dre� Final Inspection by: --------------- ----- --------------------------------------Date -------------- - - / SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M