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Fd'R OFFICE USE: APPLICATION FOR SANITATION PERMIT j� -------- Permit No.. - __._-_q_____-""""----------1 --"- (Complete in Triplicate) ---------=- --- 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: l --CENSUS TRACT JOB ADDRESS/LOC 10 � - - --- Phone-�S Owners Name - - - ------------------ -- ------- �I__� -------------------------- City --------------------------------------------------- Addressy License # l+ �-----___-- Phone ------- •- - ---- Contractor s Name __ ___...? --.,----- Sc - ------------------- - - Installation will serve,." Residence []-Apartment House Commercial :[ Trailet Court --Motel- Other- -•., = -'e'' "'"_ " � .. ❑- - ry l f� NuMber of living units_____________ Number of bedrooms -___________Garbage Gri er _______^-__ Lot Size __._.- _ _____ -1_ --- Water Supply: Public System and name --'---"--------------------- - r " .c c.c�--------•---------------- Character - ------'----------Private ❑"-' Peat Sand Loam Clay Loam ❑ " Character ofsoil to a'-depth of 3 feet: Sand"❑``, Silt❑ Clay ❑ : -,Peat tf ❑ Y. Y, Hardpan [] Adobe Fill Material ------ --- if yes, type ------------------------- ` (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be,placed on reverse side.) i�► NEW INSTALLATION: (No septic tank or seepage,pit permitted if public sewer is available within 200 feet,) l PACKAGE TREATMENT [ ] [ ] - Liquid Depth __________________________ SEPTIC TANK 3 ' Size - �_ �•W: . q p Ca acit Type ' NI`aterial---- ---------------- No. Compartments ------- --------- ,. .., Distance to nearest.: Well __"---------------------------------Foundation ------___-------------- Prop. Line __________...---•_-_-- LEACHING LINE_;C ] No. of Lines ------------"�---------- Length of each line------------------ --------- Total Length --------- 'D'-Box ------------ Type Filter Material ____________________Depth Filter Material --------------------------------------------- Property -_------------------•----------- ------ 'i Distance to nearest: Well --_ - ------ Foundation -------------------- Property Line ___--------------,•--_-- SEEPAGE PIT C ] Depth ------ Diameter , - ------ Number ---------------------------- Rock Filled Yes ❑ No i❑ - . . -- ------Rock Size ------------------------- Wat�er Table Depth - ---- E Distance to nearest: Well ------ ---- --f------------------ Foundation -------------------- Prop. Line ---------------------- -tom....... r •� _-Date -----------------1 REPAIR./ADDITION(Prev. Sanitation:Re.rmit # ----- 'Septic Tank (Specify-Requirements) ------------------ -- -------------- ------- _ - - - - Disposal Field. (Specify Requirements) -- --------------------*, .c .r.�°L :. ----- , ---- i ---- --=-----------=-----------=------------ w- (Draw existing and required addition on-reverse side)- I hereby certify that 1 have prepared this applicotion'and tFiat 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 liven. sed agents signature certifies the following: "1 certify that in the performance of the work for which_this� . permit is issued, I s_ha_ll not employ any person in such manner ! as to become subject to Workman's Compensation laws ofCalifornia." Signed -------------------- - =---------------I-------- Owner -------- ----------- -- ------- - - ' tle '� .------ ------------ ----------- Ti (If other n owner[ - t , DEPARTMENT USE ONLY I APPLICATION ACCEPTED BYs ------ DATE rz -`-7�---- ------- -- - ------------- BUILDING PERMIT ISSUED ----- _ DATE -------------•---------- •---- ADDITIONALCOMMENTS = - -- ------------------------------------------------ ------------------------"----------------------- f _7� `=7v------ = l -- --t� r;- --- -------------------------------------------------------------------- ---------- -----•--- --- ---- -------------------------------- -------------------------------------- Final Inspection by: _- -_ -..Dote ---. =--,f=- - N JOAQUIN LOCAL HEALTH DISTRICT { E. H. 9 1-'68 v. SM