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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------- (Complete in Triplicate) '--•.... ---------- This Permit Expires 1 Year From Date Issued Date Issued ?// 7 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 _ /'� _ _ �` ' . �z/ _ .� ----- ----- ----.--Phone - ri Address --- � �--/ /1--------------------------------- City : - - Contractor's Name ___ _ �L :,t,►-s '- 473 Phone __ __ _ _ - -._a- ___-__.License # __ Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other ---- -=------------------------------------- Number of living units:--- Number of bedrooms __'�------Garba e 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 ❑ AdobeFill 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.) N' 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 -------------------- Type -------------------- Material___ ------ No. Compartments --------- ....... Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ...................... LEACHING LINE [ ] No. of Lines -------/-------------- Length of each .line______}�___C __..___._____- Total Length _ _._ r fr D' BoxC __ Type Filter Material _�_ _ `�:Depth Filter Material .___, _............................... �5. f Distance to nearest: Well ____,/ - Foundation ._-_/��_ ____________ Property Line. __ _ _._______......._ SEEPAGE,^PIT �[ ] Depth _ _____ Diameter _ _______ Number ..__-_ %/_____________ Rock Filled Yes C3y' ,� r -Z Water Table Depth ------------ --------------------------------------------Rock Size K- ------Z�.•. Distance to nearest: Well ___ _ -A------------------Foundation ___el .C�----------- Prop. Line ......Is............ REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date -_.___-_______---._-__--_-----_-__) Septic Tank (Specify Requirements) --------------------------------- -------------------------- ----- --- Disposal Field (Specify Requirements) ------ ' -;-.--, ./----- ------ t = ------- ----- --- 014 ---------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 erti �re fies the following: "I certify that irt�t,h performance of the work for which this permit is issued, I shall not employ any person in such manner as to become . ub' ct to or an'smp ation laws of California." Signed ---- -- =----- ------- `------ sat _ 4-C_ - Owner BY -------'----------------------------- -- Title = _ rte_._ ge ---------- ------------------------ (if other than o ed i FOR DEPARTMENT USE O LY DATE - ' -----p. �- APPLICATION ACCEPTED BY - /`r'�l� .- ------ r BUILDING PERMIT ISSUED __ _ ___ --------------DATE ------------------------------------------- ADDITIONAL ___________ _ _ _ ADDITIONALCOMMENTS ----- --------------------------------------- ------------------- -------------------------------------------------------------- ---------- -------- ------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- -------- -- --TAN -------------- I - -� Final Inspection by: ., - - Date r°----- - JO QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M