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FOR OFFICE USE: c '� APPLICATION FOR.-SANITATION PERMIT (Complete in Triplicate) Permit No: .-71..5C 0 -------------------------------------------------------- , This,Permit Expires 1 Year From Date Issued Date Issued 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 complia ce with County Ordinance No. 549 and existing Rules and Regulations: f JOB ADDRESS/LOCATION .----- ----�-�---------------------- -- ------------------------CENSUS TRACT ------..------•......._-- Owner's Name ------�-m------1.►----c-- - ---------- -------Phone Address ---------- --'7 ................. City -1�1/�- fir _ Contractor's Name - ---------••- ------_------.License T��f . Phone / / Installation will serve: Residence E;rApartment House❑ Commercial ;❑Trailer Court ❑ a Motel ❑Other -------- Number of living units:---f------ Number of bedrooms _3-----Garbage Grinder ------------ Lot Size ----------------------- Water Supply: Public System and name ----------------------------- ---------------------- _Privateer Character of soil to a depth.of.3.feet :—Sand Silt❑ (Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, type ---------------- --------- (Plot plan, showing size of lot, location of system 1n relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: I {No septic tank or seepage pit permitte' if public sewer is available w'th'in 200 feet,} *, -PACKAGE TREATMENT [ ] SEPTIC TANK[ Siz . iquid Depth ................... Capacity - ------------------ Type ---------------- --- Material--------------------.- No. Compartments p :.....:..... .... ,,,•-. 1Distance to nearest: Well ---------------- -------------------Foundation -_---___-_------___- Prop. Line .............. ._ LEACHING_LINE [ j No: of Lines --------—_ ----------- Length f each line--------------------------- Total Length -------•---- 'D' Box ---i-------- Type!Filter Materia --------------------Depth Filter M teriai -------------- -------- Distance to nearest: Well -------------- -------- Foundation ------------__-_ ----_- Property Line --___- :-___ r SEEPAGE PITT [ ,) Depth -------------------- Diameter _--- - -------- Number --------- --------- -------- Rock Filled Yes ❑ No i[3 Water Table Depth -------------------- ----------------=---•----Rock Size ---- -------------•------------ C .-.. Distance tol nearest: Well .--_-------- ------_-_-__-_-_-__------Foundation ------_-_- Prop. Line _.._-:�-_....._.. � ---------- - REPAIRJADDITION(Prev. Sanitation:Permit# --_-____.----_- - ---------------------- Date ------- -- -----•--- ------------- Septic ------------Se tic Tank S eci fy Requirements) } ---- ----------------------------------------------------- Disposal Field (Specify Require, nts l ,�llf� %Ylji �. . f / , w --------- l2API-X- -------3 = --------- - - --------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify thaf I have prepared this application and that the work will be done in accordance with San Joaquin County-Ordinances,lstate 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 theiperformanceof 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 - -------------- 4 By --------- --- ----- -- --- -- � Title (If othe'r.t an owne-_')------- .r}• . ` f "-'FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----------"_-_r---��___ -------------------------- -_ �-----� ------------------ BUILDING PERMIT ISSUEDDATE-------------DATE ----------- ------------------------- ADDITIONAL COMMENTS ------------------------------------------------- - ' --------------------------------------------------------- - r -------------------------------------- ------------ -------- -------------------------- --------------------- --------- ----- ----------- ---- --- ------Final Inspection by. --------•-----------------------------•------------------------------ ------Date ---�� ' SAN JOAQUIN LOCAL HEALTH DISTRICT k� E. H. 9 1-'68 Rev, 5M