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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -- �-- �; --------- -- -- �� ---- Permit No. _.�f----------- (Complete in Triplicate} 1 f �� This Permit Expires 1 Year From Date Issued Date Issued ------------ kf 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 County'Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .--- - a.-f--- --- ,,�'- -- ` - -------------CENSUS TRACT -------------- ----------- Owner's Name ;-/..---.< /Cr -------- --------=- -------------------Phone ------ -------------------------------- - --- Address _ ---- --------- ------------------------------------------------- City -----------------------------------------.......... Contractor's Name ------ ore---�� `----------------------------------License Phone��.� _:... Installation will serve: Residence EjApartment House 10 Commercial ❑Trailer Goer Motel [] I Other -------------------------------------------- �y # Number of living units:----1 Number of bedrooms -.0--_____Garbage'Grinder / '__iLot Size � _�_......_. # r _ e { l ,_. Water Supply: Public System and name _______________-'______"� --_- Private`' e Character of soil to a depth of 3 feet: Sand❑ Silt Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam( W E Hardpan ❑ Adobe'❑ Fill Material ------------4f yes,type .....------------------------ (Plot ---------------- -----(Plot plan, showing size of lot, location of system in relation to wells, buildingss etc. must be placed on reverse side.) 4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer isavailable within 200 feet,] PACKAGE TREATMENT { ] SEPTIC TANK:[c] Size-_ = f _. --------._ Liquid Depth _________,_____ f CapacityP ___.__ Type _ Material_ !'J, �?.___ No. Compartments Distance to nearest: Wel �� _- - - Fovr'�dation / -_____.___ Prop. Line -C /` p- P• LEACHING LINE [ ] No. of Lines _____ _______________ Length of each line X�a Total Length ' D' Box R_ Type Filter Materiae % Depth Filter Material `` � / - --------- ---------------•------- 01 Distance to nearest: Well R.47,----_-_.-- Foundation , `_._�--------- Property Line. 11* a -_____ SEEPAGE PIT [ ] Depth ------- Diameters'__ Number ____/---------------------- Rock Filled Yes ° No . w-S+ew,.ata7 d f/ Water Table Depth '____. _ Rock Size_ -• _________________ --------------- - -------------- Distance to nearest: Well _. -----------------------Foundationf j1-*9,eP __ Prop. Line Z29 REPAIR/ADDITION(Prev. Sanitation-Permit#____________________________________________ Date ---------------------------------- " f' 1 +. J Septic Tank (Specify Requirements]'--------=1-------- ------------ ----- --------------I---------------------------. --------------------- " Disposal Field '(Specify Requirements) --------------- ---------------------------------------- ------ -------------------------------------------------------------------------------------------------- 1 (Draw existing and required addition on reverse side) tw 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: x "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." , 4 r t Signed ----- - -- -- - ---------------------- Owner BY -- - -- ------- - ---- Title 4 ._ .. ._Y__________________________________ (If?I-- owner) f ' " A 4 T USE ONLY APPLICATION ACCEPTED BY---------- ------- l --- - -- ------------------------------------------- DATE ------- BUILDING PERMIT ISSUED ----------- - -------- --------------DATE ------- --- ------------- - ----- -- ---------------- - ------------- ---------------- - -- ADDITIONAL COMM TS, _y^ y i ------------ ---- -.�---- f ------------------------ ------ -------------------------- f -------------------- --------------------- ---- -- ' ----- - r - ------------------------------------------------------------------------------ ------------- Final Inspection by: - ------- --- -- - - - - Date _.. �71 . - :-- S JOAQUlN LOCAL HEALTH DISTRICT , ' �� E. H 9 -1-'68 Rev. 5M ' .. t• t` :) . �,. , ; (.i