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FOR OFFICE USE: APPLICATION FOR SANIT TION PERMIT / (Complete in Tripli tate) Permit No lOx-- ----. ------------- This Permit Expires 1 Year Frolm 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 apgfat �a ,in codnpi9 cewi#h �u�� ndn.g No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -----.-_ _ ------------- ---------------CENSUS TRACT ---------------------- - Owner's Name --------- -1 ---------------------•--- •--------------•--- -- P�41ne -Addressf-0/_s92-- � CitY �- ----------- - Contractor's Name / < Lr ------------------------------------------------------------License # ------- -.- ------ one ---------- Installation will serve: Residence ❑Apartment House❑ Commercial:❑Trailer Curr# 4 V Motel ❑Other -------------------------------------------- Number of living units:--- ------- INumber of. bedrooms _-An-----Garbage Grinder - •-- LotjSize` '' ----------------------- ------- -- - ---_-------- ---'-------------------- Water Supply: Public System and nalme _______________________________________-_____- -__ - - - Private Character of soil to a depth-of 3 feet Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy'Loam fM Clay Loam;❑ A. \ Hardpan ❑ Adobe ❑ .Fill Material ------------ If yes,type ---------- --------------- (Plot plan, showing size of lot, location of system in relation toy Wells, buildings,' etc. 'must be placed on reverse side.) U1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is}available within 200 feet,] C PACKAGE TREATMENT [ ] SEPTIC TANK' -Size- r-_ ._ 1'_- -`--------.- j liquid Depth --------------------- Capacity ----------- •-------Capacity 1J--p-a----- Type c, - Mafierial---------------------- No. Compartments -�-----------= Distance to nearest: Well ---4-O-----------------i---_ Fbundation._2'-`--------------- Prop. Line -S ....__--- LEACHING LINE ( ] No. of Lines --�'---------------- Length of each line----�D__-------------- Total Length 1AC-L..........--.. 'D' Box -�4�€----- Type Filter Material/47-_16------------Depth Filter Material Jlf---•------------------------------•- Distance to nearest: Well --- ------------- Foundation-.__ ------------- Property Line, 5------------.--._.... SEEPAGE PIT [ ] Depth --------r------------ Diameter ---------------- Number -----:-----------------------Rock Filled Yes '❑ No 0 Water Tablet Depth ---------- --------------------------------------Rock Size ------------------------•------- ' Distance to nearest: Well ------------------------------------------Foundation -------------------- Prop. Line ............._---.--_- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------ --- ------- 'Date--:------_------- Septic Tank (Specify Requirements) -------------------------------------Y------------------------------------------- -------------------------, ------------------- ....... I 1 Disposal Field (Specify Requirerrients) ---------------------------•-------- -- - ------ ------------------------------------- --------------------------------------- ---------------------------------------------------------- -------------------------- ---------------------------------------- ----------------------------------------- ----- -------- ---------------------------------------- --------------------- ------------------------------------------------------------------------------------------------------------------- T (Draw existing and required addition on reverse'sidi=) ' 1 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: "1 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 beco subject to Workman's Compensation laws of California." Signed -------- ---------------------------------------------------------------- Owner i BY ------- ------------------------------ = (If other than owned .Title -------------------------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..-Zt . l_-s G_ --------------- -------------------------------------------- . DATE _//---�-��---•- ti ------------------ BUILDINGPERMIT ISSUED -------------------------- -----------------------J-1-----------------------------------i--------------DATE ------------------------------------------- ADDITIONAL COMMENTS ----------------� --------- - - ---------------------------------------------------------- --i--------------------------------- ----------------------------------------------------------------------------------------------------------- ----------------------------------------- -------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------ -------------------------------------- - --------- ------- ---------- ----=------- FinalInspection by: - --------------------------------------------------------------------------------.Date - ------- -- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.