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,,JOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT Permit No. - ---------- ------ , ---------------------- - -- ------ - -- ------------------ - --- (Complete in Triplicate) -------- -------- Date Issued This Permit Expires I Year From 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 complia ce with County Ordinance No. 549 and existing Rules and Regulations: r ;e-- -- CENSUS e R�ems'__________ _______________ JOB ADDRESS/LOCATION .__ - ! - - --------------- o ----- Owner's Name ------ ---- - Address ---------------- - ;Z6 ------ rGr --- ------------ City y^; { License Phone V6_ __ 0�--7 Contractor's Name ---- ---- -------- ---- ------- ----:-- - ------- -F------------- Installation will serve: i Residence' Apartment House❑ Commercial ❑Trailer Coin l❑ Motel ❑Other ------------------------------- ------- ---- 7----------- � Number of living units:___:._[---- Number of bedrooms _--�----Garbage Grinder _______.-_ Lot Size -� Private Water Supply: Public System-and name ----------------------- - --------------------------- `t Peat Sand Loam ❑ Clay Loam Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ Y Y e ---------------------------- Hprdpan,�. Adobe Fill Material ------------ I es, 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,) j ��/ � ---------- Liquid Depth _Ag 7- ---------• !„ PACKAGE TREATMENT_4( ]:. SEPTIC,TANKX S- e-----AdJl_ - ai �� _ -�� No. Compartments -_1i�-----•--- �Capaci#y�__- :--- ---- Type ---- ----- ---�--- Material----------- -- -- - p h o't � 6 _ Founclationi-i,__G_--"--.-- -- Prop. Line,--- --------•- I Distance to nearest: Well ______-sly--t------------ - ,. LEACHING LINE No. of Lihes.._1_--�� --------- Length of/�each Qline ___ lw------ --- Total Length -- �-•- p' Box _�--_✓Type Filter Material __i�` ----Depth Filter Material ."_lam-��- ---------------••------d0 r` . 'l-Q=-J—-Pro' er Lirtie --- Fou" - p : Distance Sto nearest: Well ___�-`-�-+---- ndationp f i 7 " I Rock Filled Yes No i❑� ' Depth Diameter _7_r--_""-- Number -'_��-- .- --- z, SEEPAGE PIT j P ---�>---- --- / Water Table Depth __ ____.------- Rock Size'_1- -"--x-- s j --- Line -• -----•---- . j677 ?~---------- -Foundation Prop. U . Distance to nearest:,Wellg.�'�______________ _ __ ___ ; I - - --------------- Date ---------------- ) REPAIR/ADDITION(Frau. Sanitation Permit , I ` Septic Tank (Specify Requirements) -------- ------ ---------------------- ----------------------------------------------- ------------------------------- - - Disposal Field (Specify Requirements ______________________________ , ----------------- ------------------------------------- --------------------------- --------------------------------------------------------------------------------------- ------------------------- -------- ---------- ----------------------------------------=-------------------------- -- - - (Draw existing and.required addition on reverse'side) 1 have prepared this application and that the work will be done in accordance with San Joaquin I hereby certify that p p 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: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to Workman's-Compensation-laws-of California:"- -� Signed _ ___4-- - Owner C. A U.X: t''f'r..- �. l ,Tit e -..__ ----- ------- W . (If othn owner) FOR DEPARTMENT USE ONLY . ----------------------------------- DATE ----- --- - ------------ BUILDING PERMIT ISSj-2�T�l APPLICATION ACCEPTED BY ------'��'---t- - - -- - - ---------------------------- - ------------ -----------------DATE -------------•----- -------- --------- - -------- - -------- -----------------------�------ - ADDITIONALCOMMENTS ------------------------------------------------------------------------------- ------------------------- -----------------------=---------- - -- - - -- - -- - --------------------------------------------- ----------------------------------------------- ----- - -Q �� Final Inspection bY: ---- ---------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M