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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' (Complete in Triplicate) Permit No. __ -1_-__2-__9,3 r► r A 4 --- -------------------------- 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 m de- iq�mpliance with County Ordinance No. 549 and existin Rules and Regulations: - �••� JOB ADDRESS/LOC TI N ,�0 ---------CENSUS TRACT ' `� �? Owner's Name * J� --- [ - - Phone Address ------------ `- - - C -1 ------•--. Cit ✓ -f �' Y ` ------------------------ _ Contractor's Name ---L A . - --------------License # la_ ' Phone _ G /Z ------ Installation will serve: Residence�artment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------ Number of living units:------_-�-- Number of bedrooms'--___7 .__Garbage Grinde��i A ---- Lot Size �� Water Supply: Public System and name __-__ ❑ ' ----------------------------------------------- Private Character of soil to a depth of 3 feet: Sand'❑ ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ill 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,) J PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size__-- XIX j Liquid 'i�� � . 21Capacity At�_'----- Type „ 0 d�Z_ Material � Com Compartments Distance to nearest: Well' �--------------------- -- ---------Foundation -. - - /-- - --------- Prop. Line ---------------- LEACHING LINE [ No. of Lines-___--- ---- Length of each line-*S--_&_&- -------- Total Length2�J--� 'D' Box -tit --- _��_- Type Filter Material '�-cf�_bepth Filter Material _---.r -------------------------------- Distance to nearest: Wel! _--_-'------------ Foundation ---------- Property Line -� /-_-. -_ SEEPAGE PIT [K Depth -c-A>--_-------- Diameter - `r-_-- Number -------2 - -------- -----•Rock Filled Yes i(] Water Table Depth --------------------------------------Rock Sizel - Distance to nearest: Weli ---------------.�-------------Foundation _- ------- Prop. Line � _, ----------- REPAIR/ADDITION(Prev. Sanitation Permit# __.----------------------------------------- Date ---------------------------------- Septic -------------------- -Septic Tank (Specify Requirements) --------------------- - Disposal Field (Specify Requirements) ----- - - --------------------------------------------------------- -------------------------------------- ------------------ (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 as to become subject to Workman's Compensation laws of California." Signed ------------------------------------ -- - ------------ -- --------------------------------- Owner BY c ------- , `' ---------- WF - ---`-------------- title (If other th ner) F R �DEPRTMENT USE ONLY APPLICATION ACCEPTED BY .(-'--..d3_ __. DATE --I Q_':- -9'-------------------------- TS 1_ -- - -- ---- ---------------------------------------------------- BUILDING PERMIT ISSUED -______--- DATE AL COMMENTS --------------- ------------ -- - ---- -------------------------------------------------------------------------------------------------------•---------------- --- --- --- - ------ ------ ------- - - -� --=,T�-------- r-`�------- ----- r 7 ��i �f - ��- Final Inspection by: ------------------Date ------ ---------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M