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FOR OFFICE USE: `Y APPLICATION FOR SANITATION PERMIT Permit No. "_ `��Z� / v (Complepe in Triplicate) _7 .. - ------ - ,..6------------ This Permit Expires 1 Year From Date Issued Date Issued ../1 -._- 1 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 Cou y Ordinance No. 549 and existing Rules and Regulations: p� f� JOB ADDRESS/LOCATION ._��4-,- e /' *`---------- ------------------CENSUS TRACT --------------------- Owner's Name / ��r _ f , f—: ,/ {� - ----- --�/--� - ------ ------------------ =---------------------Phone --- -- -- ------------------•-•-- AddressCity .e , - ---------------------------------------- Cantractor's Name .".___ /� �/ ` License # Phon f I Installation will serve: ResidenceX Apartment House❑ Commercial:❑Trailer Court i❑ Motel ❑ Other ---= ------------ Number of living units:./------ Number of bedrooms..----Garbage Grinder/&,0__-- Lot Size -IV-49 ------- Water Supply: Public System and name --------------------- -------�__._ Private - --------------------------------------------------- -- depth of 3 feet: Sand Silt`❑I lay P F] PeaY E_ Sandy Loam ❑ Clay Loam Character of soil to a de ❑ , Hardpan ❑ Adobe'[] y Iiill Material -----.._."__ If yes, tyke,--------------------------- a. A (Plot plan, showing size of lot, location of system in relation towells, buildings, etc. must-be placed -on reverse side.} F NEW INSTALLATION: (No septic tank or seepage pit permitted if pt#lic sewer is available within 200 fe6t,) PACKAGE TREATMENT ( ] SEPTIC TANK'[ ] Size--------------m -------------------------- -- Liquid Depth -_------------------------ ",a Capacity ---------I----------- Type -------------------- Material--- ------------ No. Compartments -------------•-----•-- Distance to nearest: Well ------------------------------------Foundation -------------.-------- Prop. Line ---•-•---------------- LEACHING LINE".,,,[_], No..of.Lines..._Tt�_____ -------- Length of each line---------------m------------°Total Length ---------------------------- 'D' Box --------- Type Filter Material -------- .___-_-.-.Depth Filter Material -------------------------------------------- ' { Distance to nearest: Well --------------------- -- Foundation ----.-------------_----- Property Line ----------.----•-------- SEEPAGE PITT [ ] /Depth ---------- ------- ---------------- Number --------------- "___ Rock Filled Yes ❑ No i❑ Water Table Depth --------------------------------------Rock Size ------------------ Distance ----------------Distance to nearest: Well -._'--------------------- __-..Foundation --------- ------------------ - Prop. Line ----------- � REPAIR/ADDITION(Prey.-Sanitation-Permit# ----------------------- --------------------- Date ------------'--------------____-- ] Septic Tank (Specify Requirements) -------_---.-- -- -------------------------------- -. Disposal Field [Specify Requirements) ._ _ ___� -------_� :.� / - ------------- - ------------ ------- - - -------- ----------------------------------------------------M--------------M__--- --------(Draw existing and required addition on reverse side) 1 hereby certify that F 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 J6aquin'Lo4tal'Health4District. Home owner or licen- sed,agents signature certifies the following: "I certify that in the performance of the work for which this lermit is issued, I shall not *Wploy any person in such manner as to become subject to Workman's Compensation laws-of California." ` Signed ------------------------ --- ----- Owner + t ) e ------ ------- = BY ---------------------- -----`- -- Title -- = . (If oth an owner) ------ ------------ . FTMENT USE ONLY i APPLICATION ACCEPTED BY --- J = ' DATE `�1 BUILDING PERMIT ISSUED ------- _ l : _ -- /~ - "" ID(TIOrI�#L COMMS ------- -- ------- - -------i --------------- ----------DATE 1 //[[ -- �' ------- ----- - ------ + - ' ,t _.:_ Final Inspection by: tZ-" ------- -- - ---- - -- -- - -- - -- -------------,Date ---�f`r�-`---- - JOAQUIN LOCAL :HEALTH DISTRICT E. H. 9 --1-'68 W-5—M—