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ii FOR OFFICE US5:. - 70 `� APPLICATION FOR SANITATION PERMIT ------ a (Complete in Triplicate) Permit No. ------------------------- -----------------------------I 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 with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATIONr __�T.�P_--__--__/r�--- _�j fs� �j CENSUS TRACT ---- ----- _-- -- Owner's Name _ � -- ---------- " '.'"�,T/r1- =1------, -, ----- --------- --------- ----- Phone - ------------------------------------- Address /J/ ,"-.47� --------------- Contractor's Cityf/ I`7 -------•----------------- Name __-_ _ � J Q .��1 --------------------------------License #�+� ,2. Phone46 --_26 4!:� Installation will serve: Residence�9Apartment House,[] Commercial ❑Trailer Court ;❑ Motel ❑ Other Number of living units..--./-- - Number of bedrooms - -_--_Garbage Grinder _ Lot Size -f ----------__ Water Supply: Public System and name -d-Alz P--- ----------------------------------- -- � -- --- Private ❑ Character of soil to a depth of 3 feet: Sand'C Silt❑ Clay ❑ Peat❑ Sandy Loam .0 Clay Loam 0 Hardpan ❑ Adobe X Fill Material ------------ If yes,type ------------------------ --- (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,) PACKAGE TREATMENT ` [ ] SEPTIC TANK Size-- �i � ��--�------ � -- ----=- Liquid Depth `�- �------------ Capacity _l;Zpr i--- TYPe "� Materia! &~-,----- No. Compartments Distance to nearest: Well ------------------------------------Foundation --fQ --__---_- prop. Line _►LEAC --- ---- HING LINE � No. of Lines ------ Prop. Length of each line._ �� -�67--------- ------ Total Length ---4�`/.1--------------• - \f D' Boxlv_rnlearest; �Type Filter Material % -Depth Filter MaterialDistance Well !' "� --_T-- Foundation '– / ��- --------- - Property Line ---�- - .....••-- SEEPAGE PIT Depth `'_ _ __ Diameter &u?------ Number ------ ------ Rock Filled YesA No i0 Water Table Depth __--- ---_- -----------------------------Rock Size/ -t Distance to nearest: Well ----------------------------------------Foundation ---�`�--.- ----- Prop. Line - --------- _-- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- ------- Date ---_---_- Septic Tank (Specify Requirements) _-_, + .1 j f -------) 6�------------ Disposal ------ Field (Specify Requirements) - _/ J ------ - ----- .....ox y I herebycern that I have prepared this application and that th (draw existing and required addition on reverse side} e 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- ---- --- - ---- -- -------- ---- - - Owner - --------------------------------------- BY ------<------. ----- - - /--- -----. Title ----- (I er than ow�erj �-t�-� -r-------------- ------- ------ ARTMENT USE ONLY APPLICATION ACCEPTED BY --._ BUILDING PERMIT ISSUED p ADDITIONAL OMMEN ~�i DATE - - ------ - -------- -- ri = Jd t --------- ------------------- ---------- - -- - --- ina Inspection by: ------------- ----------------------------------- --------------------Date --- -- ¢ ---�'-~ -�------- --- JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M