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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - --- -- - --------------• - , (Complete in Triplicate) Permit No: _7�__�`13- - ---------------------------------------------------- --- -------------- ------------------------------------------ This Permit Expires i Year From Date Issued 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 Ordinanc _No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-- � D--- ----- �'c ----.--�Jl_------ -- - - tl�_------CENSUS TRACT -------------------------- Owner s Name ----- ------------------------------------ --------Phone ------ --------------- Address ----- --------------------------------------- Cit ----------t =.... Contractor's Name -------License # �7j Phone _��_��_ � Installation will serve: Residence A artment House Commercial Trailer Court p ❑ ❑ ❑ Motel Other -------------------------------------------- Number of living units:---- Number of bedrooms ____X-_Garbage Grinder ------------ Lot Size ...... ............. Water Supply: Public System and name -----------&--, ` wfJxw— - --- -------------------------------------------------Private F-1Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe>k 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,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth -------------------------- l5%//o Capacity -------------------- Type -------------------- Material------------------ --- No. Compartments Distance to nearest: Well ------------------------------------Foundation -- --------_--------_ Prop. Line -___---__....._. f ...... LEACHING ONE [ ] No. of Lines __..__�______________ Length of each line____-_ 1. _------ Total Length --- � ............ /i r, rl b' Box Ceram___ Type Filter Material l x_ -____Depth Filter Material --___� ........... ....... Distance to nearest: Well ...... f=oundation _1Q------------- Property Line ___--.�._.--...... f rr SEEPAGE PET_ [ ] Depth Diameter - __ _ Number RockSi e y_ y"Rock filled Yes No ❑ Water Table Depth �7--------------------------------- -X 4x Distance to nearest: Well ....... 2E-----------------Foundation __RC2___.______ Prop. Line ___�+_._________._. REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ______________.___________________) Septic Tank (Specify Requirements) ----------------- --------------------- ---------------------- �------------- Disp sal Field (Specify Requirement$) �______lry�. _r____ __1�____ -. `-______ - -- ----------------------- - - X---z(-Draw _ --------------------------------------------- --------- --- ------- ex sting and requi 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. Horne owner or licen- sed agents signature certifies the following: "I certify that in th rmance of the work for which this permit is issued, I shall not employ any person in such manner as to become su Iec o W rk attCompensation laws of California." �a Signed C, s ------ Owner BY - -------- ------ Title ----- -- ----- ----- - - - - --------------------------------------------------- (If other thw own 11 OR DEPARTME US_k ONLY APPLICATION ACCEPTED B s - ------ -------------- ----- - -----£ ------r-------------- - ------ DATE -- ��----------------- BUILD PERMIT ISSUE ------------ -------- f �� DATE ADD 10 AL COMM T --- ------ --------- - •-- -------------------------- ------ ______-- __ _ _ __ _ ------___ _ __ Vll _ __ _ ----- "__ ____________ _ __ ------------------------------------------------- ---- -------- --- - ----- ---------------------- (-Fina spection by: ----- ------- --- --- ---- -- - ------ ---------------------Date --------------------------- SAN JOAQUIN LOCAL H H DISTRICT E. H. 9 1-'68 Rev. 5M