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FOR OFFICE USE:_ APPLICATION FOR SANITATION PERMIT i Permit No. -- --- - -- -------------- (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 �trcnd install the work herein described. This application is made in ccompliance with iCounty Ordinance No. 549 a Rules and Regulations: JOB ADDRESS/LOC _ ;(-�� ` , -- --•---- - ------- - -------CE CENSUS TRACT ----------------- Owner's Name, ------------------ o •-----•-• Address ------- - ------%�---- ---- City -----------------• •-•-•- Contractor's Name �'-- �-tea-- I License # - � _Phone ------------------•-_-------- Installation will serve: Residence [�artment House'❑ Commercial:❑Trailer Court i❑ Motel ❑Other ------------=-`-------------------------- - Number of living units:_--f___ Number of bedrooms �_---Garbage Grinder ------------ Lot Size - „� ,...... Water Supply: Public System and name - ------- ----------------------- r-i�------------------------------------------•---------------------Private [� Character of soil to a depth of 3 feet: Sand',❑ Silt❑ Clay ❑., Peat❑ Sandy Loam ❑ Clay Loam:5t� HardpanT❑ Adobe❑=Fill Nlateria'I ---- If yes, type -------------- {Plot plan, showing size o'010&i,locations 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 [: SizeZ/ --------- Liquid Dept9 --------------1.: . ` �+ rapacity Pwe '-- Type ----------------- Materials - ---- No. Compartments oZ-____------ s � ' f Distance t6•_rtea?it: Well -- -.----� ----�--------------Foundation .-._Ld---- Prop. Line /_`-5--__- _ LEACHING LINE [/j/No. of Line --------- ----- Length of.each line------ Total Length ;.-02- i` _ 'D' Box --. �`S Type Filter Material ----- -- -------Depth Filter Material ----- Q__��--_-._----.---------_-_-_-- t w` # -------- Foundation --_- ---47-_--_-_-_ PropertyLine. ----i Distance o nearest: Well ----, ____ .--.__-__ SEEPAGE PIT [ ] Depth -------------------- Diameter --___---_-----_ Number ---------------------------- Rock Filled 'Yes ❑ No-C Water Table Depth r -------------------------------------• ------Rock Size ------- ----------------••---- � Distance to nearest: Well ----------------------------------------Foundation ----- ---------------- Prop. Line _------------- REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date --------------•-----------------•- i Septic Tank (Specify Requirements( ---- ----------------------------------------------------------------------------------------:--------------- < Disposal Field (Specify Requirements) ------------------ ! } I (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 ith 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: F "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.” Signed -------------- -------- - --- -------------- Owner ► BY ----------- r Title -_ .d'nril/t(� 15 - ----- ------- --- d- ---------------- (If of er than owner) i FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY - ------------------------------------------------------- DATE " �� BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------;----------_-DATE = ADDITIONAL COMMENTS ----------------------------------------------------------------------------- ! - - ----------------- ------------------------------------------ Final ------- --- -Inspection bY: -------------------- -------•---------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT ` E. H. 9 1-'68 Rev. 5M. i� I