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.FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ............................. ............ (Complete in Triplicate) Permit No,--? -. •._ "•-" ............... This Permit Expires 1 Year FromQate lssved Date Issued •-7�p Application.is hereby made to the�Son Joaquin Local Health District for a permit to construct and install the work herein described, This application is made in compliance with ounty Or inance No. 549 and existing Rules and Regulations..JOB ADDRESSAOCs Name ATION .. — .-. Owner' -- „r--• � •-------..... ............. .. _. JJ CENSUS TRACT ...---•--• Address Pone ................ . ............. ................... .•-•----•--. City •• ........................._.......:... Contractor's Name -. .... F - + 1 I�1-dr -_-----..._.License # � ' ,. .___...............`:. Phone Installation will serve: Resldence Apartment House0 Commercial 'j]Trailer Court �� Motel []Other . • - Number of living units:.__... ..... Number of bedrooms .°., arba eTGrinder ............:lot Size w r p Water Supply: Public System /��..----.... Y and name .._..._,.�,� I Character of soil to a depth of 3 feet: Sand ---••-----••------....__Private 0 i 1] Silt❑ Gay ❑ Peat❑ Sandy Loam 0 Clay Loam i Hardpan Adobe,'[) Fill Material ----- ...... If yes, (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc: must be placed on reverse side.) ' NEW INSTALLATION: f (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} (PACKAGE TREATMENT [ I SEPTIC TANK i t Size..---••--••- ' _......._................... .... liquid Depth Capacity ..----•-••-----•-- T e'= �•-•• - - YP -•-----•- Material---........-•-----••-- No. Compartments ...:.......... Distance to nearest: Well " ------_-:-___- _•.--.......Foundation. Prop. Line ... . - r LEACHING LINE [ ] No. of Lines / . ... �•-----....... length of each line...--- �� Total Length ..40...... 'D' Box ......._._._ Type Filter Material ....................Depth Filter Materia! Distance to nearest: Well ----= ------------_ Foundation " Property Line } Jar . ��, _..-------••---•---..... C I Depth�-�f C�,��6iameter -...._._ - Number ..._ Rock Filled Yes No ,- + •. Water Table Depth =: `=71ock Size w Distance to nearest: Well..................... ...•- _ Foundation ........ __ ----..... p. Line REPAIR/ADDITION Wrev. Sanitation Permit Pro - Date - -•-••------- Septic Tank (Specify Requirements) -------..__.- �. �.---,1--•-•-----••-.:•-- ................--- - �Dispp2o._sal Field (Specify Re irem nts) _ - . -------• - °-- -------...- {Draw existing and required addition on reverse side} -----------------•------•---•---- I hereby certify that I have prepared this application and'#at the workwill be done in accordance with San Joaquin I County Ordinances, State Laws, and Rules'and Regulations of the San Joaquin Local'.Health District. Home own or licen- sed agents signature certifies the following: —.. t ' °'I certify that in the performance of the work for which this permit is issued, 1 shall of em to an as to become subject to Workman's Compensation laws of California." r ploy Y person'in such manner Signed ------------- I .:....--••-----• •------•--•-•--...._ Owner $y .. - �- • ------ -- --- ----- --- - �. .. • -•-------•------••--. title __..._..._.......:_..._........_...._. . (if other than owner) ............................ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - x BUILDING PERMIT ISSUED .. -------------------------------------...-------••---••--••--.... , DATE _.. .o . .?_ ........:..... ADDITIONAL COMMENTS .....---__ .DATE ...........................•._............._ ..... ............................. ........_............................_..I... ..._ .. ....._........_..........._..................._..__•.... 4 _ _ r __•..................................................................... Final Inspection by: ;._..... •- .................................... .......................•................. -Date _.. .. ... SAN JOAQUIN -LOCAL HEALTH DISTRICT 'E. H 13 2-41-'68 Rev. SM