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FOR OFFICE USE: �. _ ------------------------------------------ APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) ' Permit No. This Permit Expires 1 Year From Date Issued Date issued ---S_- -7i- Application is hereby made to th San Joaquin Local Health District for a permit to construct an described. This application is made in compliance with County Ordinance No. 549 and existing Rules talnd ltegulatonsl the work rein r JOB ADDRESS/LOCATION __3_ ------vi _-- ---------------------------------- -------CENSUS TRACT -f:3. . Owner's Name �c�st/ttif -""--- 1 �� ---- - ---- ----- Phone Address _------S/9 - ------------ --------------- �� Contractor's Name __.__ SUR/ License # ----------------- Phone Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court ;❑ E Motel ❑Other Number of living units:___------ Number of bedrooms _2----- Grinder ____._______ Lot Size ___7_ �2.LS Water Supply: Public System and name _________________________ ------------------------------ ---- -------Private ------------------------- ------------------ Character of soil to a depth of 3 feet, Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ,F Clay Loam Hardpan ❑ Adobe ❑ Fill Material ----_------- If yes�etc. type ---------------------------- {Plot plan, showing size of lot, location of system ;n�reanto wells, buildingmustbe 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 Size------------------------------------------------ Liquid Depth - ------------ ------- CapacitY -- Type -------------------- Material---------- ----------- No. Compartments Distance to nearest: Well -------------------------- ________Foundation ____________ •- -- - ----- Prop. Line ----------------------- �..) LEACHING LINE [ ] No. of Lines ______________ ______ Length of each fine__------------------------__ Total Length ___Z 'D' Box -___ ----- - Type Filter Material ________________--Depth Filter Material ____________._ .. ------------- --------- Distance to nearest: Well _____________._ - Foundation .... �-�-- -= I - - - -------------"-_--- Property line SEEPAGE PIT [ ] Depth -------------------- Diameter ---•-------"""-- Number ----------------------"""--- Rock Filled Yes [] No ❑ 1, � Water Table Depth ------------------------------------------------- I ------------------------Rock Size Distance to nearest: Well ---------------- -- --Foundation -------------------- Prop. Line ----•----------•------ : REPAIR/ADDITION anP ermit# - Date ! ------------ - -SePc (Specify(Prev.Reqrements) ---------•--------------------------- ------------- ----------- D• -- ----- (Specify : _--- ...... --- ------- ---------------t- ---- GC�t / / , cmc_ -----� ----------- �J. /----- -- -- - - -- ----A-J n--- ----------------•------------ - � • s ---------------- ---- ---------------------------------------- - ------- ---------------------------------------------------- raw 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 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: "I certify that in the performance ollthe work for which this permit is issued I shall not employ an as to become ubject to Workm n's Co ens ion laws of California." P Y Y person in such manner pens Owner------ --- ---- BY ----------------- Title . -------------------------------- - --- - - (If other than owner) F R .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ __ __ ________ --------------------- F - ----- DATE - ------7 - --- ------- BUILDING PERMIT ISSUED --------------------------------------- ------ -------------------------- --------------DATE ADDITIONAL COMMENTS --------------------"__-- ------"- --------- ---� ---------------- -------------------------------- -- ----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- -------- --- - -- ---------------------------------------------------------------I------------------- ------------------------------------ 1 -- -- n - - --- -- - - -- -- --------- ------------------------------------ ------------------------ ---------- Final Inspection by: __ _ __ _ Date _ r +_�_ • ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M