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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . .:��.. !Complete Irl'Triplicate! Permit No. _ :.- ..... .......... ......... --- •• : (` This Permit Expires 1 Year From Date Issued Date Issued I 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. JOB ADDN.RaE._.SmS_AOC� t4 S. -.- . _^'` - .r,r_ -• -- = - E PhS~T RACT .......... .Owner's e.- one Addres . F. ,City Contractor's'Nome ... - t , # icense . f !' . . Phone ........................... Installation will serve: : Residence.�Apartment House] Commercial❑Trailer Court C] Motel ❑Other _----•- ..................•--••. ....... . v Number of living units:..__..._.. Number of bedrooms '._..---Garbage Grinder .._.._-..... Lot.Size ................. Water-Supply: Public System and name .......................................... -------------- Private [�}� Character of soil to a'depth of 3 feet: Sand❑ 'Silt❑ Clay ❑ peat[i 5andy loam ❑ Clay Loam Hardpan Adobe'[] Fill-Material=--'::_..:.. If yes,type _..__ _...._,-_ - . {Plot pian,.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 j ] SEPTI TANKfI'� 5iz _. d ��,� `.�............... Liquid Deptli .44 l Capacity 1�.4_�......-- TYpe � "" � Material.. .. ......... o men _" Na C m rt ts' . _ ,.� .. ` t Distance to#nearest• Well f • -------.�ta...........:.:�.._Foundat�on _JR.."_...... Prop. Line' -•� LEACHING !lNEi ( No, of Lines _...._ ............. Length of each line.:__... ........ Total length t D' Box �" Type Filter Material ._. ,� _. be th Filter Material I�'...__ .� p Distance tonearest• Well .. Foundation ` �� :prop d5' � .....�.---•• '� ................ erty--Line w SEEPAGE- IT Depth ��-""-- Diamete/V •. Number .� z;_t._�� %~- ;_,'Rock filled .Yes_ o O c Water Table, Depth - �1 a . / ........... ..Rock Size . - { Distance to nearest: Well �`� T�................. '"` /d r t - Foundation op, f .. .."--•............. Pr Line --- -------..._. � . REPAIR/ADDITION(Prev. Sanitation Permit# .....:...................................... Date ................................. . Septic Tank {Specify Requirements),:......................... ___......._... •...... Disposal Field (Specify Requirements) -h •••--•...............I.... •----- ._.:_.... Ar P ...p�..._.__..... ---- --.._..--••-----..-.._- ...... ... . ..... .......•-......:.--•"-... ` t ' "(Draw existirig 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. Horne 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 mannan as to become subject to Workman's Compensation laws of California." Signed _ ••--- Owner ............ ..................•........................ . . By .................................................... _ :._. . ... -• -•---• -.... _ . title _ 6 : ( other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..-•----...GrGg :.. I BUILDING PERMIT ISSUED t ............... :...... DATE 7 ADDITIONAL COMMENTS .1a.3.�7. . .. : :.: .::::-F.�.....--- ..............."--_......__.._._......................................._- •. ___---.........w* _.• ._..........._............................_._._._.........:._-......_................ _..____... .. ..__ .�._. _ ............................ ......................................... ....__.r.._... -f..---..._.... Final Inspection by ..Date .............•. SAN JOAQUIN -LOCAL HEALTH DISTRICT 3E H.13 24 1-'68 Rev. SM - � ,-... -N 1