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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i b ;z.Q -du Permit No:T�-__�'7 - -------------------- --- (Complete in Triplicate) --------------------- 3 -------- Date Ensued 6 This Permit Expires 1 Year From Date Issued p V �. J _____________________________- .. - 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: CENSUS TRACT ---______--------------- JOB ADDRESS/LOCATION ----- -��----��-------��-�,��"/� ----------- - ----------- - ---- /� s- ----------------------- - f Owner's Name ----- �--------fix �:� ---- --�- /� ------------------ .Phone. =-j-s- Address --- Cityl RPh F �' Contractor s Name ____1f�,�'� ----, � ------ _____-__. License # one �Wj- Installation will-serve-----^ -Residence X Apartment-House❑ Commercial ;OTrailer Court ❑ Motel ❑Other -------------------------------------------- t r� jO �4V ---------------- E Number of living units:-/------- Number of bedrooms .__cry_--_Garbage Grinder _�/_--- Lot Size _ __ _- Water Supply.'Public SylLeM and name -----------�---------- -------------------=-=------------------------ ---------------------- -----------Private ❑ Character of soil to a depth of 3 feet: Sand'E] 0 Silt -'.Clay ❑ Peat ElSandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe g 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'{ I __ Size----------------------------------------------- Liquid Depth _-----------------.------- Capacity ------ Ca acit __- T e -------------------- Material = No. Compartments -----------------_. - � P Y YP lr Distance to nearest. Well __-;,__-----------------------------Foundation ---------------------- Prop. Line ---•------ ------LEACHING LINE [ I No, of Lines --------------------- Length of each line-------------------_-- --- Total Length -----.----,-------•-------- 'D' Box ----------- Type Filter tMaterial -------------------Depth Filtef, Material --------------------.-------------- - Distance to nearest: Well --- -------`------------ Foundation ------------------------ Property Line ----------•------ •-------. [ 1 p ------------ ------ Diameter...___------------- Number -- ---------------------- Rock Filled Yes C] No ❑ SEEPAGE PIT Depth , Water Table Depth ------------ -------Rock Size,---- -------------------------- ` Distance to nearest: Well ---------"----------------------- Foundationti -,------------------- Prop. Line _..---------- •----- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date-----------------------------------) Septic Tank (Specify Requirements) ----------------------------------J --------------- -------------------------- -------- ------ ----------------------- , Disposal Field. {Specify .Requirements) .------�- �� .3-�� 1� ��- ��"" � � --- ----------------^�Z1 ----- .� �� / 4 A r ' ------------------------------ ----------- i -------- - ---------------------------------------------------- _ � (Draw existing and required addition ori reverse side)_ 1 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 r, {Ifo r than w er} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - DATE ----� � `� --------------- -------------- BUILDING PERMIT ISSUED _.- ------ - DAT ---- -------------------------------------- BUILDING COMMENTS ---------------------------- - ------------- ----------------------------------------------- ----- __ ---- Final Inspection by: �� --- -------------- ------------- r SAN JOAQUIN LOCAL. HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.