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FOR OFFICE USE::EAPPLICATION FOR SANITATION PERMIT Permit No. ,3__�% ------------ ------------- ------------- 'Complete in Triplicate] Date Issued ------ ------------------•-------'------_________.___ AVI This Permit Expires 1 Year From Date Issued 7" 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 with County Ordinance No. 549 and existing-'Rules and Regulations: I JOB ADDRESSAOCATION ._ ' / / �r f' ---- --------------------- y– -- _--__CENSUS TRACT -----------------•-___-- , i Owner's Named ------1 l&A'�/�/ F -----------Phone Address ---------------- f ----------------------------- =--------------------------------------------- - City. -----_ - J Contractor's Name .- ---------.License , �. �-_ Phone _-. � _ F � Installation will serve: Residence�Apartment House`❑ Commercial :❑Trailer Court ;❑ Motel ❑Other-------------- Number of living units:--/---__ Number of bedrooms __f__ Garbage Grinder IP10- Lot Size � ' "_________________ Water Supply: Public System and name ---------------------------------------Private ❑ Character of soil to a depth of 3 feet Sand'❑ Silt❑ Clay ❑ Peat❑ . Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------- _ If yes, type _____:___'`_-______ r _ -------- ° (Prot plan, showing size of- lot, location of system.in�relation to wells, buildings, .etc. must be placed on reverse side.) r NEW INSTALLATION:,: '(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK Size't` --------_.---------- Liquid Depth _�__________________ NNO r Capacity/490,------- Typ -- Material ------ No. Compartments -14—..........:.... Distance to nearest: Well ------__ ____ -----------------Foundation __��-___-__-___ Prop. Line LEACHING LINE. �(f No. of Liries .01 / Length of each line__ ----------------- Total Length D' $ox . _ '_ Type Filter Material� � _Depth Filter Material � � I i Distance to nearest: Well ------------ Foundation -0 e_11------------ Propprty Line -.�07_- SEEPAGE PIT Depth __ _____ � __ _ �i�_________-___: Rock` Filled Yes4' No ❑ �_-_. Diameter _ ____ Number _._-._ __- Water Table Depth -- �°"`��r± ' Rock Size fDistance to nearest: Well ..______-_' ""`_________________Foundation -_P�'___ ____ Prop. Line 41----------------- REPAIR/ADDITION(Prev. Sanitation Permit# ________________ --------- -- ---------- Date ---------------------- -----------! Septic Tank (Specify Requirements) ----------------- ----------------------------------------- Disposal Field (Specify Requirements) ------- --------------- -- ----------- ----- - v, --------------------- - 9 J (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. Home owner or (icen- sed agents signature certifies-the followingc�'v. €`,I 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 become subject to Workman's Compensation laws of Coliforniii." Signed =' " wn r ----- ------------ --------------------------------- ---- --------------------- 4�1-� Title _ ' (If r t an owner) l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ , _ -- -- - -- - -------".----- - -------- ------- ------- DATE ----- �---- ----�--------��- BUILDING PERMIT ISSUED --- :---------- ----------DATE ADDITIONAL COMMENTS ----------------- "--------- ------------------------------------- - t ------------------------------------------------ ------------°------------------------------------ r T: - -- - ----------------------- - ----------- Final Inspection by: --- - --- - --------------------- --- ------ --- ------- ----------- ---- -------.Date SAN JOAQ LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M 4�• � � *��