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'�' .r '• ' FOR OFFICE USE: � y .+ APPLICATION FOR SANITATION PERMIT permit No. (Complete in Triplicate) ------------------------------ --------------------------- � This Permit Expires ires 1 Year From Date Issued Date Issued --r�-�--7v -- / \ Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATI .-----. -- - - - a CENSUS TRACT -------------- ---- Owner's Name - G � ! Phone .� �� iCity 'rlt~=------------------------- --------- Address ------------- +.s-- b License # ta Phone. .��.�. Contractor's Name t Installation will serve: Residence�Apartment House Commercial ❑Trailer Court i❑ Motel ❑Other ----------------------•--------------------- ' ""Lot Size ._- ------ • Number of living units:--._�--._ Number of bedrooms ---_-�-__Garbage Grinder __ __. ,-----=- Water Supply: Public System and name ____---- -�' Private [ -- ------ -------- -- -------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam .E] 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.} S NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 244 feet,) I re �z ----------• - Liquid Depth ---------------- PACKAGE TREATMENT [ � SEPTIC TANK'[ ) Al ,� � � ---------- --------- --•--- --- - --------- --- Type -------- ---------- Material----- --------- -- No. Compartments -------•--------...... Capacity -------------- yp Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --_---•------=--•- Tota LEACHING LINE [ No. of Lines ------ -___ l Length ,---gZ-47-_-.-_ ------------- Length of each line-- --- � ---- 9 ooe 'D' Box ___�__- - Type Material ------Depth Filter Material ____- __ � -------------� ---• ---- Distance 7 e Filter Mat - / ----------- Pro er Line -----A------- ... Distance to nearest. Well _- '______________ Foundation _--- p tY �p Diameter -_- ee Number _---. _._-----.__-- Rock Filled Yes Ig' No SEEPAGE PIT [ Depth _co"------- s I �,,, Rock Size ----- ----- -------- Water Table Depth ---------�V------ ---------------------- ,... ,. I Distance to nearest: Well ......��- ------------------------Foundation -_. �--=------ Prop. Line ---•--------- -•------ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----- ----------- - -------------- Date ------------- ------ ------ Septic -Septic Tank (Specify Requirements) ----- --------------------------- ------- ---------------------- -------------- p Disposal Field (Specify Requirements) _-_---__ -----,--�- R --- - - -- ------------------- r l m� ,r - `------- ----------------------------------------------------------I-------------------------------- ------------------------ ------ - - t (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: W: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such mariner as to become subject to Workman's Compensation laws of California." Signed --- ------------------------------------------. -------------------------------- ----------------. Owner _ :-_ ? �.�_-� �=''�".-,- -- �_% _ _oe -�°----------- - title --------- �'".----=-- ---`�=------- --------------- By ------------ - - (if other than owner) ,. FO EPARTME E ONLY APPLICATION ACCEPTED _____ DATE _. _ -- J-p/-y- _ ________ _ ___________________.--__-_ n / .___-- .--------- BUILDING PERMIT ISSUED --------------------------------------------------------------- DATE -------------------------------- ADDITIONAL COMMENTS -------------- ---------- - ----------- ----------------------------------------- - ------------------------- ------------------------------- I --------------------------------- ------------ -------- --------•------ --------------------------- -- - -- - - --- ---------------- ------------------------------- ------------- ------- ----- - a �- __ ---- - -- Date _ � ---��- Final Inspection by: ----- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E H- 9 1-'68 Rev. 5M .