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FOR OFFICE USE: k I APPLICATION FOR SANITATION PERMIT ----=------ -----------------------•-------------_-- - _,- -. - Permit --_ _ _- IComplete in Triplicbtel ., Q_ ` _____. ------------------------------- ------ - F Date'lssued �- ---------- ---------_------------- ---------------I This Permit Expires 1 Year From Dale 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 compliance with County Ordinance No.r549 and existing Rules and Regulations: f, JOB. ADDRESS/LOCATION -- /,_--We -------- ----CENSUS TRACT ------------ ------------- Owner's Name.------ ----- ---------=-=-------------------Phone .----------------------------------- .rJ s Address ----- -- e,44-4� :-------------------- City `_ -- ti Contractor's Name / _ � _____________ License # -- �� - Phone _________.___________._ ----- Installation will serve: Residen�6%Apartment House�❑ Commercial :❑Trailer Court i❑ { -- /Motel ❑ Other ---- -- I----- .------------------------- Number of living units:_-__ ____ Number,of bedrooms __ ---.Garbage Grinder/-------- Lot Size Ag!9_____ 4 Water Supply: Public System and name --_- ass.: ____________________________________ ____Ori ate ❑ Character of soil=to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ___________ If yes, type ____________________________ k' (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 Si e__- -_ ✓ -�_________________..__ Liquid Depth:,.$_� `R---------- Capacity . __ ____ Capacity '.__ Ty..pe __, Material- fW. -_ No. Compartments�'r!- - p ----------,---- Distance to nearest: Well t___-_____`_______________________Foundation ---L°��_______ Prop. Line e -_--_.______ LEACHING LINE No. of Lines t.___ ,______'`_`___ Length of each line___. i___._..__ Tota! Length __..___._ __ r' 'D' Box . _X_"0__-Type Filter Material A<AgVO_'1r__Depth Filter Material �f--__________________ _____________ l r F f Distant �to nearest: WeIV------- __.____._-__ Foundation ____.f_ -------- Property Line -_ ----------- �t E SEEPAGE R1T Q Depth _____`-___._Diameter �Zv`---- Number ___Z--------------------- Rock Filled Yes ,k No 0 i Water Table Depth ---___ ----------"_�-__:__� �___..___.Rock Size - -_r-_ _f____._______ f I Distance to nearest: Well _________��____________—____.Foundation _________ Prop. Line ., _,.__-t_ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------- `tl r4'j Septic'Tank (Specify Requirements) -------------------------------------------------------------------------- -------=------- --------------- _---------------- -------- w Dispqsal Field (Specify Requirements) __________________ ---------------------------------------------------------- ---- f F , (Draw existing and Fequired addition on reverse side) I hereby certify that I have prepared this application and that the-work will be de 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: F "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 subject to Workman's Compensa ion laws of California." Signed ------------------------- -`=-------- --- -------- - ------ `='` ------ Owner By -------- ---- --- ---- - --- sy; ---------------- Title ----- (If othe an owner} ti F R`DEPARTMENT USE ONLY k i APPLICATION ACCEPTED ------ - ----------------- v a --------------------------------- DATE --------- -------- BUILDING PERMIT ISSUED ------------------ ----------------------------------------------- -- ----------------- -------------DATE ----------------------------------------- ADDITIONAL COMMENTS ---- ------------------------- --------------- -------- - ---------------- ------------------------------------------------ - - --------------------------- - - - ---- ------------------------------------------------ --:`_---------------------------- ------- -------------------------------- ---- - Final Inspection ----------------------------------------------_---- ------------------- Z;,-7�-7v-- Date'- ".- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M '