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FOR OFFICE USE. 7 APPLICATION FOR SANITATION PERMIT b (Complete in Triplicate] Perm ...... it No. .. ........." .......... 'es .ed Date Issued ��'/A....7S1 ••"•-.•. This Permit Ex ices 1 Year From Dale Issu Application is�hereb f PP y made to the San Joaquin Local Health-District for a permit to A 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 ADDRESS/LOCATION Owner's Name ... CT ......._..._._... ......CENSUS TRA ..__`._.---- Address ' .. Phone ._. City ' eAme - - --- _ Contractor's Nome _.. ..... .- --��..�_Tv�.--.�----------------------------...............License # ,ate-'l.'�_..�.._ Phone -- ��•• Installation will serve. Residence WAportment House 0 Commercial ❑Trailer Court Motel ❑Other ............... :. Number of livingunits:.. �+ .."... Number of bedrooms ....;?--.-.Garbage Grinder ./�f Lot Size Water Supply: Public System and name --------------------- ................ Private, Character of soil to a depth-of-3-feet-1---Sand-C] _ Silt❑ Clay ❑ Pe- at❑ Sandy Loam fl Clay Loam ❑ Hardpan-o.._ .Adobe J3 Fill Material ............ If yes, (Plot plan, showing size of lot, locaron 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,TANKT Sixe...-------•-•--•--------•----------------------- Liquid Depth .............. -•-- V Capacity ' Type =................ Material. No. Compartments Distance to'nearest. Well ......................... .----Foundation ..--"----------------- Prop. Line ...................... LEACHING LINE [ ) No. of Lines ----------------------- Length of each—line. ------- Total Length ..- ........................ D' 'Box Type Filter Material «• r ."-- {---.Depth .Filter Materia! ------------------ - Distance to nearest: Well ........ •.............. foundation "-"---. ........_--- ....... Property tine ._ ........... SEEPAGE PIT [ ) " , D"epth _....--- Diameter ..........-•---- Number. --------- ................ Filled Yes No Wat'e'r,Table.,Depth ------------------------------------------------Rock Size . Distance to nearest: Well ----------------- ---- Foundation`___- Proe p. Lin ______•----------_--. c !T ......_..____--. - REPAIR/ADDITION(Prev. Sanitation Permit# ---------------- _.- Date Septic Tank (Specify Requirements)-..-.'-,,-,. ..........•................................ Disposal Field (Specify Requirements) -: �'- „___• � � "�,f _^ ;! , -------------------------- k (Draw existing and required addition_on..reverrsese.---. ....sid..e..)........................................................... 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: 1•_,__ Y "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 ...................... --- -----------•-- yy Owner BY r _s. itle - (If t an owner) ............ ............ F DEPARTMENT USE ONLY ' - APPLICATION ACCEPTED BY __. ......__. ,�-: BUILDING PERMIT ISSUED ....... -•_. .. DATEZ-2-4/4(7, ....... ...... ADDITIONAL , .DATE........_ COMMENTS ------------•---•----•. _..*.. ............ ................................•.-----......_....-----•-- . .. =�---- -----•-••------- ........ ....... Final inspection by:: _..: _........._ D ......... ...... ...............•-- ... ate ... . SAN JOAQUIN LOCAL HEALTH DISTRICT ,.F• H.13 4-l-'68 Rev. 5M _ • _