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,-11 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT lnolS, z Permit No. -- (Complete in Triplicate) a } Date Issued �----`-`---_-G---- This Permit Expires 1 Year From Date Issued Application is hereby made to the�San Joaquin Local Health District for Aermit 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 ADDRESS/LOCATION ------ --- -- =-.----------------------CENSUS',TRACT ~_!__ ------------ i j r PhoneyOwner's Name -------- ----4 1-----21-- ----- ---- -- CityAddress ----------------- -- Contractor's Name ------- ---- ____ -- 9-.W— -AL-4- ----License #XrYrAr7-�-:-Phone .----------------------______ Installation will serve: Residence PrApartment House❑ Commercial :❑Trailer Court i❑ Motel FI-Other - ------------=--------------------------- Number -- -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 E] Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material - If yes, type ___________________________ ` d (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Q NEW INSTALLATION: (No septictankor seep Size a pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT SEPTIC TANK [ " a r --- ��'_X c� - -- ------------ Liquid Depth -- -- - ---- [ ] ,Y ___ _ __ _ . No. Compartments - ---------- Capacity SAa- Type _ . Material Distance to nearesWell -�--------.5f__-__----_------Foundation _.___/_ ......... Prop. Line _--------------- LEACHING LINE [ - No. of Lines'____.;1_-`.,_ _-_- Length of each line__---94 1------------- Total Length ., !>_______________ .-'D'-Box _-:_ ------- Type Filter Material ------Depth Filter Material ---L_ ----------._____________________- _ Distancet nearest: Well --------- Foundation ------------ Property Line __________________\ SEEPAGE PIT [ ] Depth ____' ------------ Diameter ________________ Number ---------------------------- Rock Filled"Yes Yes ❑ No ,0 � r Water Table Depth ------------------------------------------------Rock Size -------- ----------- p. Line _._._____.___________. n 1 -•---- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ________- -_.______________} ! , � Sepfiic Tank (Specify Requirements) ------------- - - ---------------------------------- ------------ ----------------------------- ------------------- I -- --- --------- DisposalField {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 las to become subject to Workman's Compensation laws of California." I i Signed ----- -----------------------�. �owned. -- Owner r-� l` c Title Q- [- BY / ---------------------------- [If other tha r - FOR DEPARTMENT USE ONLY g DATE APPLICATION ACCEPTED B 44 _ ___ _________________________________ --------------------------------------- _� - � (- BUILDING PERMIT ISSUED # ---------------------------------------------------- DATE ADDITIONALCOMMENTS ---------- --------- --------------------------------------------------------------------------------------------------------------------------------------- i ----------------------------------------- ----- -------------------------------------------------------------------------------------------------------------- --------------------- --- ---- ---- ---------------------- ------------------------- -------------------------------- -----= ----- Final Inspection by: ----- -- ---------------------------------------------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M