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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - / - ---� Permit No. may - (Complete in Triplicate) This Permit Expires 1.Year From Date Issued Date Issued 0 by 3k 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 a isting Rules and Regulations: i I � I JOB ADDRESS/LOCATI N l �Q ------- ---- ( d -- -- . ---CENSUS TRACT _ -------------------------- -- ---- _ --Phone ------------------------------------Owner's Name `--------------- ------ ------- Address ----- -- - -- ----- . City -------------------------••--.-••-- Contractor's Name ----- r__._______¢____ ______.________License Phone Installation will serve: Residence;4 Apartment House❑ Commercial :❑Trailer Court i❑ / Motel ❑ Other -------------'------------------------------- Number of living units:----_/.__---- Number of bedrooms __�V____:__Garbage GrinderlVe-!0 Lot Size 45;�&04�10��______________ Water Supply: Public System and name --------------------------------- ------------------------------------------------------ ---------------------Private , Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam E] i €` - i Hardpan E] Adobe -E] Fill Material --__------_ If yes, type ---------------------------- { 44� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seepage pit,per mitted if pubic sewer is available within 200 feet,) l� •y'PACKAGE TREATMENT { ] SEPTIC TANK Size3X_9X __�.' _)KJ1 Liquid Depth _X !___________ r Capacit��__-_l.��P_fype ___ ! Material�`�11 No. Compartments tr _ ,� -- ---_ d Distance to nearest: Well * ,�._ ______Foun*dation'_ h � -- -- - ----- --- < < ��--------- Prop. Line ------ LEACHING LINE No. of Lines. -------------------- Length of ach line/�.___a��I.3.a�Total Length 9A�_�_. 'D' Box __ 49� Type Filter MateriallZoWai l epth Filter Material /fl_____________________---------------- Distance ____ __________ . Distance to nearest: Well _- �__ ___________ Foundation � � � - `fa----------------- Property Line ---�------- SEEPAGE PIT r' Depth ---t%01-------- Diameter _� ----- Number >- ---------------IF Rock Filled Yes)g No i❑ Water Table Depth ------ ---'------------=--------Rock Size ------- Distance to nearest: Well _Z---_____________________Foundation _ta4'1117---------- Prop. Line ...... 1 REPAIR/ADDITION(Prev. Sanitation tPermit# -.----._ ------------------------------- Date ---------------------------------- _.... ....-.tea Septic Tank (Specify Requirements) a __ -__ --_�_~_____ � Disposal Field {Specify_Requirements) ________ ___ _____________________________ I yyyggg)- • 6 --------------------------------- -- -- _.___________-------------------------------------------- -------------- to, 11 - (DraW existing� and required addition on reverse sidel 1 hereby certify that I have prepared this application and that the work will be done intaccordance with San Joaquin County Ordinances, St'6te Laws, ands Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature,certifies theflolfowing: -- �-- "I certify that in the performance of; he work for which this permit is issued, I shall not employ any person in such manner t as to become subject to Workman's Compensation laws of California." a Signed ---_- F Owner L� r By ' �' --- ----- ------------------- B ---- - �(lot�er --- - =- - � ------- - -------------------------- Title ---- _thanownerJ tt` _ t FOR DEPARTMENT USE ONLY �q Olt x APPLICATION 'ACCEPTED ;BY - =------------ - ---- ----- - --------------- -------------------•----- ------------ DATE ------------------- " BUILDING PERMIT ISSUED"-"------------------------------- --------------------------PATE --------------------------- t ADDITIONAL COMMENTS ----------------'` --------------------- ---- s ------------------------ -------------------------- ------- - -------------- ---i- ------- -------k-------------------------------------------------- -------------------- - ------- � --------------------------------------------------------------- �-- -- - --Final Inspection by --------- -- -- - - -� - ---------- ------- -------- -------------------------------------------- -,Date --- 1,------- --- ------- —SAN.JOAQUIN ,LOCAL.HEALTH DISTRICT�y E. H. 9 1-'68 Rev. 5Mg _ -