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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------- - - Permit No. io - ------------------ (Complete in Triplicate) ------- I---------------------------------------------- 1 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 made in compliance w' h County Ordinance No. 549 and existing Rules and Rulations: JOB ADDRESS/LOCATi ' N . _ _ r - . --CENSUS T RACT _ _.. -------- --------------------------------------------- --------- ----------------------------------------- --------- - ----PhoneOwners Name - --------------- r , Address City ----•----------- Contractor's Name ._1f____ _ �___ _ _44 _ -- " ---' - _8_____ _ _ 0 __.License # -.��-�f�-7"- Phone Installation will serve: esiden&XApartment Hous '❑ Commercial ❑Trailer Court i❑ Motel ❑Other __}+ �. ------------------------------------ or f n, - - / Number of living u ----- Number of bedrooms __Garbage Grinder �'LotSize __t_ Q______7�-__F------- --- Water Supply: Public System and name --=----------__ -_ _ __-- Private ❑ f k Character of soil to a depth of 3 feet: Sand'❑ Silt(]_Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,❑ i Hardpan ❑ Adobe rV Fill Material ------------ If yes,type ____________________________ Y " (Plat plan, showing size of lot, location of system in relation to wells, buildings,!etc. must be placed on reverse side.) v NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) F PACKAGE TREATMENT [ I SEPTIC TANK --------- ___ _ _______.__ Liquid Depth -_��--------- Capacity _49MAType No. Compartments ___!------------- Distance to nearest: Weil ------------Foundation ------- Prop. Line LEACHING LINE No, of Lines __ Length of each line._____��_--________--__ Total Length ____-�-�:0---___-- - �^o e 'D' Box ____�------ Type Filter Material °_________ _.Depth Filter Material ___ _f_______________________r_-•-__ Distance to inearest: Well _J_aa� Fours ation -__=1__a__.____ Property Line ---- SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number __________.____._____=____ Rock Filled Yes ❑ No I❑ Water Table Depth ____________, ' _-____Rock Size '______________________ -------------------------- - --------- Distance to nearest: Well __________--__________ _________________Foundation _---_-_-__.__�_.____ Prop. Line ....-__..____._.___._ ._,. REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------- -------------- Date ---------_-------_----------------1 Septic Tank (Specify Requirements) ------------------- ----- '= #- , Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------------------- ------------------ --------------- s ----------------------------- ' --------------------------------------------------------------------------------------- --------------------------------------------- (Draw existing and required addition on reverse side) I I hereby certify thatI 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: a "I certify that in the performance of the work for whi��this p rmit is issued, I shall not employ any person in such manner as to beJa#AdA6N#8ffW}L4( 91� §pR�gation �vs of C ifornia." -..Signed.:- --------------=------P-.--- '--3--ox_2-54---------- -------------- :_ '� 160 East Grantline Road-n- ------ -- ---r-- - - - -- - --�Titole141ec ' r ---------- - ' 0 0 .. OR DEPARTMENT USE ONLY `" _..r APPLICATION ACCEPTED BY . .� --cam-----• DATE ----f f' U-r`cS--------- BUILDING PERMIT ISSUED ---------------------------- ` _DATE ------------------- rADDITIONAL COMMENTS ---------------------------------------------- ---------Z------------------------------ ------------------------------- -------- ----------•---------------- -- _________________________________ �- --- -------- - - -- ------------------------------------------------------------------------------------------ -- _'_ - ------------------- _ Final Inspection by: ------------------------------------------------------------------------- -------- ---------------.Date ---- -V' - SAN JOAQUIN LOC LTM T CT E. H. 9 1-'68 Rev: 5M