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FOR OFFICE USE: - �-- -"___--_-_ " APPLICATION FOR SANITATION PERMIT ----------- - .3 _------- (Complete in Triplicate) Permit No. _/_`1 Issued This Permit Expires 1 Year From Date Issd - bate Issued Application is hereby made to the San Joaquin Local Health District for a ci described. This�JCATION a plication is made in compliance with County Ordinance No. 549 and existing Rules and Regulation permit to construct and install the work herein JOB .- Owner's Name " I CENSUS TRACT - l - ----- - Address -- ----- ---------- Phone - ---r---- - r ----- --------- Contractor's Name - -- -----------• Cit -- - - -------- -- License # Installation will serve: - -- - --r7-�_" Phone . =---�---------- •-- Residence partment House,E] Commercial {]Trailer Court Motel []Other Number of living units:-------If---- Number of bedrooms - -"-"-_Garbage Grinder -_-___ -__ Lot Size --_I-"_-�,-t-- Water Supply; Public System and name _ "-_-- " A. Character of soil to a depth of 3 feet: Sand'E] Silt clay -- ------ ---------------------•---- -- ------- --Private C] Peat❑ Sandy Loam '0 Clay Loam E] Hard�n [] Adobe .Fill lVlcrterial _ 1�--- if yes, type --- (Plot plan, showing size of lot, location em in elation to,wells, buildings, etc. ` NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,)must be placed on reverse side.} PACKAGE TREATMENT [ ] SEPTIC TANKV Size-- -_�}_�_lt--_�x % — . � Capacity TYpe��-� -` " Liquid Depth - r�----------- -0 Material'`c . .�No. .Compartments ---7.. Distance to nearest: Well ------------------------------------/ ""•--- LEACHING LINEFoundation ---� d.� r XS. --- ----------- Prop. Line�------•-•--------- No, of Lines e,�_-_--------- Length of each line_- j- f3"--.----- Total Length 'D' Box .%tees - Type Filter Material __ X_-�___-"_Depth Filter Materia! Distance to!! nearest: Well ----------- a Q---- -----"-- ------- ------ Foundation _"- -------------- Property Line ---3__�___-• -• " SEEPAGE PIT _ • -" [ Depth ----- --- Diameter -3-3------- Number ------ -�---------------- Rock Filled YestET--No Water Table Depth ---__- i --- ------ ------------- ----------Rock Size --- ------ Distance to nearest: Well -------�_' _f Foundation - _ --------- Prop. Line -. ---- REPAIR/ADDITION(Prev. Sanitation Permit# --------- ---- ----- ----��------ Date ------------- - - Septic Tank (Specify Requirements) ------------------------- ----------- - Disposal Field (Specify Requirements) ----------------- ------------ (�1 ----------------- ------------------ ----------- --------------------------------------------------- ----------------- --- ----------------------=------------------------ ----------------------------------------------------------- ------ - (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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .--- --- -- --- Owner BY --- ------- _ _ ___ „- -------- Title ----- -�. -�� oth r t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ---- --------- -- BUILDING PERMIT ISSUED ______"""_" DATE - - r A DDITIONAL C MENTS DATE ------------------------------------------ --alk-1 _ 1�_-11 t ,"----------- ---- --- ' -- ------------------------------------------------------------------------------------------ - ----'-------------- --------------- - ------------------------------ ------------ ----------------------------------------------- \ --- --------------------------- Final inspection by: "-." _-__"__ , -------------- - ------ ^ ----- -------Date - -- ----�--�- � -�- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M