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FOR OFFICE USE: ,e APPLICATION FOR SANITATION PERMIT (complete in Triplicate) Permit No. __ _�_ ------------------------------------------- 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 applicatio4rr, compliance with C y Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO .---- ---- - -- ---- �' ---------•- --------- CENSUS TRACTOwner's Name - --- -f ------------Phone �T".� 0. --- Address Contractor's Name -________ ¢� q- - .....�-- CL�'> ._.License #16N;-1------ Phone �?�-----J_1��.� Installation will serve: Residence XApartment House-0 Commercial Trailer Court iQ Motel ]Other Number of living u- t.r Number of bedrooms _`_Garbo e Grin er _-- _______ Lot Size ___Yl 111s Water Supply: Public System and name -------------------- __ _ - --_�'-- - . Private [] Character of soil to a depth of.3 feet:,0 xSand'Q Silt❑ Clay„ ] Peat[], Sandy Loam_ �]- _ Clay Loam Hardpgn 0l Adobe [:] Fil! 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[:] Size____________________ ----- 4 ------------------ Liquid Depth ---------------•---------• 1 Capacity -------------} Type -------------------- Material---------------------- No. Compartments -•--------- istance to nearest: Well ------------------------------------Foundation ----------- -- Prop. Line ---...------_--------- LEACHING LINE [ ] No. of Lines --_€------------_�-------Length of each line_-- _________--------_ Total Length ~u- � 'D' Box ____._-- I Type Filter Material ____________________Depth Filter Materia! � t N"3, J 1 ', Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line SEEPAGE.PIT . [ ] a Depth�_a_,____;-L-► Diameter _--_-__________ Number ---r______________________ Rack Filled Yes No 0's Water Tale Dept -- _ Rock Size f VZ ---------- Distance to nearest.-Well ____________________ ,- = Foundation -------------------- Prop. Line .-__--------- REPAIR/ADbITION(Pre.'Sanitation Permit _ gt�� Date ____ __ 60 Septic Tank (Specify Req irements) ___________ _ _ /� t f Disposal Field`(Specify Requirements) ----______ _ - ti"L ---------- ------ --------------:---- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- -------- ------- ------------------------------------------------------,---- - ------------------------------------------------------------------------------------- (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 sub.iect to Workman's Compensation laws of California." - � 9 Signed ------------------------------- - Owner ----- ---------------------------- -- By -------- -------- __r ---) ------------ Title ----------- (I other th caner X5 -1 >FQR DEPARTMENVUSE ONLY APPLICATION ACCEPTE16 D BUILDING PERMIT IED 13Y _�_.'__--- �/_ / ----------- -=-- / - - ---------------------- ------ DATE _ r SSU __________________ ---------- -----------------------DATE ------------ ADDITIONAL COMMENTS ----------------------------- -------------------------------------- - _ - -------------------------------------------- --- ------- - -------------------------------------------------------------------------------- -------------------- ---------------------------------- Final inspection by: ----- - -- - -- Qate _ _-_ --�p�--------------- AN JOAQUIN LOCAL HEALTH DISTRICT -00- F. H. 9 1-'68 Rev. 5M