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FOR OFFICE USE: 1, APPLICATION FOR SANITATION PERMIT --------- Permit No./----------------- (Complete ----------(Complete in Triplicate) This Permit'Expires-1 Year From Date Issued Date Issued --------- ] -- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install tW work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO -- ---- d '1 F - --------------------------------CENSUS TRACT --------- --------------- --------------- I � Owner's Name ----- --- '----------- - Phone Address . - -- .. ldC u--c--------------- -- City -------- ------------------------------ A.17 Contractor's Name _`{Jti ___.License # '�_ 1�� .�-- Phone ---- ---- - ----- �7 Installation will serve: Res idence-[X.Apartment House,❑ Commercial-:❑Trailer Court ',❑ Motel ❑ Other -------------------------------------------- Number of living units:-____ll------ Number of bedrooms _w_ _"___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 ❑ Adobe;[ Fill 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted .if public sewer is available;within 200 feet,) rr PACKAGE TREATMENT [� SEPTIC TANK;[ ] Size_______�11Yk ------------------- Liquid Depth .____ - ------ f� - ---- Type ---`4 f------- Material_-C44 -- No. Compartmenfis to, '" / ---- Capacity. earest: Well ------------------------------------Foundati n --':------ ------------ Prop. Line -.------- -=-�--`---- ._.____ Length of each line_�'-_�7-- /�. otal Length _._1._ �____' • ---- Distance n LEACHING LINE No. of Lines ----- 'D' Box ____� _' Type Filter Material _____- ------- Filter. Material -------------1_14P______---------=- --- �- -------,- Property Line -------��-----• ` Distance to nearest:Well-_.��___--______-:�"-__ Foundation,-._�_ __._-____ SEEPAGE PIT Depth ------ ------_ Diameter -_�_2� ---- Number .------ ------------ Rock Filled Yes 5 No i❑ Water Table a, Depth ------------------r------ ----------------------Rock Size ---- ---------------- -- r R fDistance to nearest: Well:_____y_ ��______________________Foundation ----AO ----- Prop. Line ------------ REPAIR/ADDITION(Prev. Sanitation Permit# --------- _/Va------------------------- Date -------------------------------•--1 Septic Tank (Specify Requirements) --- -------------------------------- -------------------------------------------------- -------------- .1 ---------------------------- ---------------------------I--------- Disposal Field {Specify Requirements) --------------------- =- =' --------- ------- --------- ------------ ----------- ------------------ - ------------------------------------ x {Draw existing and required addition owfeverse-side) 1 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. Hoene owner or licen- sed agents signature certifies the following: T. "1 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. " 1. signed -------------------------------------' Owner BY -------------------------- Title (If other than owner) FOR-,;DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY --- ---- --\� --------------------------------- - -- DATE �`� BUILDING PERMIT ISSUED ----- ----------- ----------- ---------------------------------- --------------------------------DATE -------------------------------------------- AD -------------------------------- ---------AD ITIONAL .COM EN -- ' ,� (� ----- - ------ 54q I' ------------ J ' -------------------------------- ----------------------------------------------- ---------------------------- ---------------------- Final Inspection by: ---- .-------------------------------------- -----_ t 1. 1�! Da e� -- - -` SAN JOAQUIN LOCAL HEALTH DISTRICT ( E. H. 9 1-'68 Rev. 5M -