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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------ Permit No. -- T (Complete in Triplicate) --------------------- ! This Permit Expires ] Year From Date Issued Date Issued -� --7 --------------------- !/- ------------- - Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATIO / __�✓''�+-__+�-fes:A-w; - -- CENSUS TRACT .-_---_------------------ - Owner's Name -------- Q --------- -/.- Phone Address ------- 4 "J./- ------------------------------------•-- t-- ------ --- ----- - -------------------- 4. Contractor's Name -- ° ------------------------------- -----.License # ---------:-------------- Phone -------------------------_-._ Installation will serve: Residence-t Apartment House❑ Commercial❑Trailer Court '❑ Motel ❑Other -------------------------------------------- Number of living units:__________ Number of bedrooms --_3------Garbage Grinder ------------ Lot Size ------------------------ W 91 ater Supply: Public System and name ---------------------------------------------------------------- -------- ----------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ - Hardpan 0 Adobe-❑ Fill Material .--- _ If yes, type --- s - - -(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,) PACKAGE TREATMENT { ] SEPTIC TANK'( Size_ 'f`-a6 --5---------- --------- Liquid Depth _ ------------------ -- Capacity IAOP-------- Type _-t Material__- No. Compartments -'---------_----- { /Distance to nearest: Well __ 4_____----_-----------------Foundation _-Jb-------------_ Prop. Line _+ ------------------ LEACHING LINE D(] No. of Lines ---.3----------------- Length of each line-------- A ----------- Total Length /�--.Cs- _--_-------_ d 'D' Box . __--_ Type Filter Material A-V---------Depth Filter Material If-11----------- w .................. ! Distance to nearest: Well ;7 f ------------- Foundation __/0_______-_______ Property Line_ 4 -------------------- SEEPAGE PIT J Depth __ _--------- Diameter -----_-- Number ------a------------------ Rock Filled Yesa] No C Water Table Depthp / ---/S7_0------- --------•----------•......Rock Size --- -��- ----------•- - Distance to nearest: Well -----------------------------Foundation ------------ Prop. Line _ ~---.._-__-_-__._. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _-----__-_--_------_--_-----_-___-) SepticTank (Specify Requirements) --------------------------------------------------- ------------------------------ ---------------------------------------------------------- Disposal Field (Specify Requirements) =------------------------------------------------------------------------------- Y -,.— - - -- — -- = - - (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 certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shah not employ any person in such manner as to become subject toWorkman'Spensation laws of California." Signedf- _= �. A Owner By --------------- ----- -- / Title --------------------------------------------------------------- -------- ------------------------------ (if other than owner) FOR DEPARTMENT USE ONLY ; p. APPLICATION ACCEPTED BY -------------------------------------------------------------------- DATE ----------------- BUILDING ------------- -BUILDING PERMIT ISSUED -------------------------------------------------------------------------------------------- --------------DATE -- -- ------- ---------- ------------------ ADDITIONAL COMMENTS - --- 9, � ,�•` ---------------- , ---------------- -------------------------------- ` Final Inspection by: ----------------- -, pate ja/a `�� SAN JOAQUIN LOCAL HEALTH DISTRICT „ -E. H. 9 1-'68 Rev. 5M _