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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------- --------- --- Permit No: -a:�' (Complete in Triplicate) V 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 _------_------------ --- Owner's Name ----- ------------------------------------------------_- -------Phone ------------------------------------ Address -If - --- :-- -------- City --r_ ---------- ----------------•- ` Contractor's Name __-__ ---------License # _122_-_ Phone�� A Installation will serve: YR eXApartment House❑ Commercial []Trailer Court I❑ Motel ❑Other _.------------------------------------------ Number of living units:----- ---- Number of bedrooms___.- ------Garbage Grinder ------------ Lot Size ------ '---�;. Water Supply: Public System and name ---- Private ---- ----- - •-- ❑ Character of soil to a_ depth of 3 feet: > Sand❑ Silt❑ Clay ❑ Peat❑ -Sandy-Loam-❑- .Clay Loam,❑ Hardpan E] Adobe Fill Material ______-_--_- If yes; #ype ----- ---------------- anti i (Plot plan, showing size of lot, location of system in relation to wells, buildings,-ettc. 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 [ ] Size -_____--- -- -------------- •-Liquid-depth -------------------- Capacity _--__-_Capacity ------------ ------- Type --------------------- Material---------------------- No. Compartments ------ ..........t =-- I Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -_.-_-_--- LEACHING LINE { ] " No. of Lines {e___t__-._________-_ Length of each line__-_ __---_'--_____ Total Length-_- ------------- =•. D' Boxes_ Type Filter Material __-�_g-------------Depth Filter Material __-- Distance to nearest: Well ---/. __-__---- Foundation __ ____-__-_---__ Property Line __.�--_.-' --- SEEPAGE PIT [ ]a �_Depth ----- Diameter . ----- - Number _ ..__-_ -------------- Rock Filled Yes„ No i❑ Water Table Depth __----_Rock Size -----------_ y f Distance to nearest: Well -- -,/ A. 0-------------------------Foundation ---/0---------- Prop. Line ....5s.-_.... _-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ___--------------_.--------_•_.---) Septic Tank (Specify Requirements) --------------------------,-----------------------------------f-- --- ----------------- ---------------------- Disposal Field (Specify Requirements) ---_ - ----4� �- --- '-----=-- i ------------ ----- ----- -- --- ---- ----- (Draw existing and required addition on reverse side) I hereby certify that- '4 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinanies, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or !ice n. agents signature certifies the following: "1 certify that in1he performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco bject to Workman's Com ensation laws of California."001 Signed . = M�e%G�I�L. ---- 'L Owner l By ----------- -- - -- -------/ ------ --- r�.�l ------------------ Title c ' (If other,1than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '-' d-Y -/'";��F DATE _3---At--- 7-2-- BUILDINGPERMIT ISSUED -----------------------------------------------�--------------- --------------------=---DATE ------------------------------ ADDITINAL COMM WT,7S---- .o ---------------------------------------------------------------------------------------------------------------- ----------------------------------------- Final Inspection by: - ------------------------------------------------------------------------- -------Date ....3_-_1_y -------------- � SAN JOAQUIN LOCAL HEALTH DISTRICT C/ E. H. 9 1-'68 Rev.'5M