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FOR OFFICE USE: ------- -------- --------- APPLICATION FOR-SANITATION PERMIT - --•---- - �� - 7/-570 {Complete in Triplicate} Permit No_ _____________________ -------------------------------------- �_____ This Permit Expires i Year from Date Issued bate Issued 5--- 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 rdinance No. 549 and existing Rule's and Regulations: JOB ADDRESS/LOCATION .__ `q ' rf --- --------- --------CENSUS TRACT ----�� ••---------• Owner's Name Address --------- -- -- ---------Phone ------------- ------------ I� .J,�j C^-1 -- -------------------------- Cit Contractor's Name -------------------------------License #�[[;�7. ?-___ Phone Installation will serve: Residence UP-9pIcirtment House❑ Commercial ❑Trailer Court ;❑ Motel [❑ Other ---------------------- Number of living units:____ __-- Number of bedrooms __X____Garbade Grinder -/ Lot Size' - / � Water Supply: Public System and name -------- ---------------------------:•-- -------- Private - - - - ---------- Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay E] Peat EJi Sandy Loam -F] Clay Loam 9 Hardpan ❑ Adobe ❑ 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 Siz;��Im ----------- --- Liquid Depth --------------- Capacity 1 /46�� Yp T e`,��, aterial_ r.{� Id<1No. Compartments _ --- Distance to nearest: Well _____- -- IP i f ----------------------Foundation _e�------------ Prop. Line .Sad_------- - LEACHING LINE [ No. of Lines _____•�________-__ Length of each line------ _°__---_ !_ l Length /-- g- Total i - ..------- D' Bo/x _((F _ Type Filter MaterI-f' __Depth Filter Material Distan nearest: Wel! ___- - -f -�-------_---- Foundation -. -------------- Property Line ---------.----- SEEPAGE PIT �r� Depth _X. --f-----, Diameter �Z - Number _-____. _____.___ Rock Filled Yes No ❑ Y ' Water Table Depth --------------------------------Rock Size ff ` .------ t Distance to nearest: Well ___ -�`_ .01 f�L-��------------•i------:- --Foundation --��-�------- Prop. Line ----------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date'-----------------------------_____I Septic Tank (Specify Requirements) - --------------------- Disposal Field {Specify Requirements] ------------------------- - ---- --------------------- r 4 -------------------------------------------------------- - --- (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 Cornpensatio laws of California." Signed -------- ---- - ----------------------- Owner ----------------- - BY - ------- -- --------- ------------- Title ----------- (If other th owners ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___ ' _ __ ____. DATE -4k7_/ ' BUILDING PERMIT ISSUED - _ A DITIONAL COMME S" - ATE ------------------------------------------- -- ---------- --------------------------------- -- - ------------------------------------------------------ -------- ------------------- ina Inspection by: _____ _ --- - ------------ -------- --------------Date SAN AQUIN LOCAL HEALTH DISTRICT E. H. 9t '68 R M