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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIV a- ----------- - (Complete in Triplicate) Permit No. - -- --------- -------------- This Permit Expires 1 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 mad mpliance with County Ordinance No. 549 and existing Rules and Regulations: 5 JOB ADDRESS/LOCATION .__-- :_-_ --- p-------�E'�---_C !M_/i�------ra,'----------------CENSUS TRACT ----- Phone s Named - -- ' ` 6e ------------------ ---------------- Address � --- pitY Contractor's Name r1 :/ - �-�------------------------= License #.2_Yc3,(_1� Phone /` '` . t Installation will serve: Residence Apartment House❑ Commerciaf ❑Trailer Court ;❑ jMotel F1 Other ------------------------------------------- Number of living units:.-!______._ Number of bedrooms -_?------Garbage Grinder ------------- Lot Size -------• kk Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private --------------------- --------------------------------•--------------------------------•-Private Character of soil to a depth of 3 feet: Sand)R silt❑ Clay ❑ Peat }❑ Sandy Loam -El Clay Loam 11i Hardpan ❑ _Adobe_❑ .Fill Material -VQ--- If yes,type ----------------------------- 4 (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,) C9 i PACKAGE TREATMENT f ] SEPTIC TANK'[ I Size------------------------------------------ Liquid Depth ------------------------ • d ' Capacity Type -------------------- Material---------------------- No. Compartments ----------..------:---- Distance to nearest: Well ------------------------------- -----Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE [ I No. of Lines -------------------=---- Length of each line---------------------- ----- Total Length -----------------_--------- 'D' Box ---f-------- Type Filter Material --------------------Depth Filter Material -------------------- ----------------------- Distance to nearest: Well ------------------------ Foundation -___----.____ ---------- Property Line ------------- - SEEPAGE PIT f ] Depth _____________ Diameter ---------------- Number ---------------------------- Rock Filled Yes '❑ - No 0 � Water Table Depth Rock Size -------------------------------- ' Distance to nearest: Well ____________________________ -----------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _--____________-------.------•---) 5eptic Tank (Specify Requirements) --_____-._ ---------------------------------- ----------------------------------------------- ------ Disposal Field (Specify Requirements) -------- ___/AP`' ��°�— ��~'�� '�Zl _ PzgE-F1i13-----CONCPi• - e,� rC ----- ANte--------_`F-Je = f I�e..M.6-�- �------ = --------------------------- ` uE7W------%CSP-c Tti 1-H77 W_nlg;�----- - f-(Draw 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. Horne owner or Hcen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner I as to become subject to Workman' Compensation laws of California." Signed _ ' ----- ------- Owner ,y ------------------------------- Title ------------------------------------------------------------------------ By I flf o er than owner] FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY -----------Ot-----------------------------------------------------------------------. DATE ------ -_----- BUILDING PERMIT ISSUED -----------r---------- -------DATE ----------------------- -------------- ADDITIONAL COMMENTS ------ ----- -- ----------------------------------- - - ----------------------------------------------------------------------------------- ---------------- -- ------------------------------------- ----- - ----- - -- ------------------------------------------------------------------------ ----------- --------------- -------- -- -------- ' ---- -------- ------- ------- } ----------------------------------- Final In ate Final Inspecti SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.