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FOR OFFICE USE: APPLICATION_ FOR SANITATION' RMIT =---------------------`- ---- � � Permit No. ------ -------------------------- � (Complete in Triplicatel . I ----------I------------------------- -------- °' Date Issued ... ___tel-'- -.. This Permit Expires 1'Year From 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 with County Ordinance No. 549 and existing Rules and Regulations: Z's ` S------ e---14—- __ - ------------ CENSUS TRACT JOB ADDRESS/LOCATII • Owner's Name ----------- --------------------Phone-----------Address �d 'S - ---- -- -- . -- -- -- ---- -- -------- ------------ City Contractor's Name ____- ----- `------License. # _��. d'_y Phone ------------------------------ --- -- ----- ----- --- Installation will serve: Resident d Apartment House[] Commercial : rail Court�❑ Motel ❑Other ------------------------------------------- Number of living units------I------ Number of bedrooms ___1-------Garbage Grinder -_____ Lot Size --__a (/ ¢ ,i . Water Supply: Public System and name ------- ----------------- ---------------------------------------------•------------- Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay [:] Peat❑ Sandy Loam ❑ Clay Loam;❑ h Hardpan V Adobe❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of lot, I'cation of system in relation to wells, buildings, lett. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ,. PACKAGE TREATMENT { ] SEPTIC TANAi, Size ._ -- ----. - ----- ---- Liquid Depth __/--------------No. Com artments [Ca aci QOypeMaterial_ -' P P tY Distance to neaell ----------``��................. Foundation ----k------------- Prop. Line ---.------�---• { I LEACHING LINE [""f No. of Lines _______ -------- ------ Length of each line_______ ____ ------ Total Length __j- 8---------------- 'D' Box _ _________ Type Filter Material _._ .! .......Depih` 'Filter Material _.__i_I----------._____`................. - - r Distance to nearest: Well ____SD_'-_____:_ Foundafiori ------------ Property Line_..____ - r s . Number __-____�u--'------------ Rock F)Iled Yes No � SEEPAGE PIT {y)/ Depth ___ ______�____ Diameter _ ___ J , jI ,. y. Water Table Depth ---------------Loo ------------------Rock Size ------- Distance to nearest: Well ---------- d7_0---------------------Foundation _____l Q__-_----- Prop. Line -` ----•--•--.----- `• ` _ REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- - Date `---=---- --------------- ----- -) � - • k Septic Tank (Specify Requirements) :ts) -------------------------------------- -------------------------------- = ------_---- ------- ---------� ----------------------..... Disposal Field (Specify Requirements) --------------._ -- ------------------------- -------------------------------------------------------------------------------------------- -------- --- - --------------------------------- . ' i (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 licen- sed agents signature certifies the following: "I certify that in the perFormance'of the work for which this permit is issued, 1 shall not employ any person in such manner I as to become subject to Workm Compensation laws of California." Signed ------------------------- ----- --- --- ------ ---- _-4BWf By ------------------------------- ------- Title ------------------------ ---------- (if other than owner) FOR DEPAR ENT USE ONLY APPLICATION ACCEPTED BY ? :r:�r -------------------------------------------------------------- DATE ---------------------- BUILDING -.--------•---•----BUILDING PERMIT ISSUED ----------------- - --=--------------DATE -------------•---- ------------------------ -- - ---------------- _ _ ADDITIONAL COMMENTS ---- --- --- F _________________________ _ - YS!_________ ___ a- -------------------------------------------------------------------------------------------------- _____________________________________________________ _------------------------------------------------- ----------_-------_-------------------------------------------------------- Final Inspection by: -- �- Date !- ` t4 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. I