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FOR OFFICE USE: -' r I APPLICATIG7._'=.x'• SANITATION PERMIT ` ----------------------- ///,to {Complete in Triplicate) Permit No. -------------- f ---------------------------------------------------- { This Permit Expires T Year From Date Issued ' Date Issued _ ----- f 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. f --- -------------------- --- JODRESS LO�ATION ---------- CENSUS A Own W. e Vif __ ,----------- --` a ------------------------ ------------------ ------Phone -------------- Address - a 19/U,44 er7—Ww 7?- 17 ---- -------------- l� Cit y ,E E Contractor's Name __.Lil/. � - ------�F ----------=---- -----------License # -2S-6-71-7--- Phone ----'UP f_ Installation will serve: Residence JM Apartment House❑ Commercial:❑Trailer Court ❑ Motel Number of living units:_._-_j_. Other __- Number of bedroom s° �-______Garbage Grinder ------------ Lot Size _��,�� Water Supply: Public System and name _________________ ________Private ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay g] Peat❑ Sandy Loam •❑ Clay Loam 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,] E PACKAGETREATMENT rSEPTIC TANK [� Size- 'J --''y -- -- -------- -- Liquid Depth ----_�-_ // �----:----- �1 f Capacitd zo._U_------ TypeAc•_[ Material o. Compartments �-- ------•--- V Distance to nearest Well ----==-----------------------Foundation _ Z --------- Prop. Line,__��._�__----------- LV LEACHING LINE [�Q No. of Lines ----e-----_____r-- Length of each line-__l__ --------- Total Length _ d�__...______ "D' Bax __ -_- T e Filter'INuteri --- ep filter Material `_ YP _f ' Distance to nearest: Well ___._�`_'` "'- Foundation ---/�_-__-________ Property Line. _ 1 n ' SEEPAGE PIT [ ] ' Depth l � d , , ---- -------•-•--- v ' ------- ----------- Diamet X__Y Number ------ --------------------- Rock Filled Yes No 0 0 Water Table .Depth --------------------------- i < � �l � ----------------------Rock Size - -- ---.2------------------ Distance ----- ----------- ' ( / Distance to nearest: Well --- ______________________-___.-Foundation X-0---------- Prop. Line ----4---/ REPAIR/ADDITION(Prev. Sanitation Permit S# -------------------------------------------- Date ---------------------------------- Septic _-__-________.__________.Se tic Tank (Specify Requirements) Disposal Field (Specify Requirements) ___________ -------------------------------------------------------------------------------- ------- ------------------------ ( - - ------------------------------------------------------------Draw existing and required addition on 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 t as to become subject to Workma Com nsation laws of California." Signed -----------�¢ �.r_' .i Z ..------------------------------------------------ k - Owner BY ------------------- --- -------- ---------- A---------------------- - Title --------------- ------(If other than owner) ------------- ` l FOR NPARTMENT USE ONLY APPLICATION ACCEPTED BY __ ---- __ _ -- - ----- ----------- DING PERMIT ISSUE DATE ---- --- ---------------A ONAL_ ---- ----- --- - -------- �f -------- - - :9 --- -- Final Inspection by ------- ----------- � �- D ----- SAN JOAQUIN LOCAL HEALTH DISTRICT __3 E. H. 9 1-'68 Rev. 5M