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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- ---------------------------------------------------- r 0 (Complete in Triplicate) �/- 3 Date Issued --------------------------------------------------------- This Permit Expires 1 Year From 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 compliance with County Ordinance No. 549 and existthg Rules and Regulations. JOB ADDRESS/LOCA ION ._-! ___7�-- /'i�-�-- A! CENSUS TRACT -------------- ---- , i Owner's Name "A--- ---•---- ----- ------ ----------- hone Address --------� Cit a Contractor's Name -- ----- --- - -.-----License # -,33 _ Phone ---------------------••------ Contractor's Name -- ----& ---Installation will serve: Residence Apartment House`)] Commercial:❑Trailer Court 1 Motel ❑.Cather ..-,-.:-� "-------------------------- L t i Number of living units:---._I_---- Num.ber-of bedrooms ---Garbage Grinder,.._ _----__ t Size __ -------------- v ' Water Su I Public 5 stem d name --------------------- - A` t ------Private ❑� Pp.Y; . Y L ^ } - ---------------- ------ ------ Character of soil to a depth of 3 feet: Sand'❑ Silt❑. : 'Cla ❑ Peat ❑ Sandy�Loam ❑ Clay Loam ❑ Hardpan.❑ Adobe' Fill Material _- =' If yes,type -------------- {---------- � „s y (Plot plan, showing-size_of.-lot,location of system in relation wells, buildings, etc. must-'be placed on reverse side.) NEW INSTALLATION:'` (No septic tank or see a pit permitted if public sewer is available within 200 feet,) , V / x PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size?- a-_ - ---------------------------- Liquid Depth `-----.------.----- I, Capacity . -SO-0 ---- Type pe.Q Material_: - --- No. Compartments. --------------- r Distance to nearest: Well -_--��_�------------------Foundation --------� 3--�---- Prop. Line ---"- ------- LEACHING LINE [IY� No. of Lines ___ ____-- 4 Length of each line -____._ - _1______---__ Total Length ___- °'`�__---..__-- 'D' Box -_� �__--- Type Filter Material ---- Depth Filter Material ----------------- ------ s E r � Dis#ante nearest: Weli'_�_�'o------------ Foundation .......lb_b_---__-_-- Property Line. ---------------- -- --- ii -- -~__- Nu _ - �-------------- SEEPAGE-PIT [� Depth ____o� 1__-- Diameter _ Number __ t` Rock Filled Yes No 0 r Water Table Depth -----___-- ----(a Size --=- ---X_ -------- _-- 4, Distance to nearest, Well ------ 5� ...Foundation ------- --------.Prop. Line ---- 4-_•-------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------:--------- -------------- Date --------.-------------------------) Septic Tank,,(Specify Requirements) -------- -------a - -------------- - Disposal Field (Specify Requirements) -------------------------------- r ------------------- A -----------------------------------------------------=------------------------ ------------------------- /' 1 1 --- -------------------------------------------------------------------------------------------------------------------------------------------------------------------1 __---_ ----------------------- (Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin I 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: 1% "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 n's Compen ." laws of California." y - kSigned _. -------------------- Owner 1` t ------ Title --z - ------ ------- -------------------------------------- --- --- -- - - (If other tha ner) � FOR .DEPAit MENT USE ONLY APPLICATION ACCEPTED By .-- --------------------I-----------4,.DATE (.'12-72X_-V---------- I-- BUILDING PERMIT ISSUED ------------- - ' ADDITIONAL COMMENTS,: _ :_ _ ------------------- -------- = = `'' _ - - --- - -- ------------------------------ -- �- F � - = ---- -- --- ----------------- Final Inspection by: _.{� __ -- '""" -- ---.Date - - ---------------------- - - SAN JOAQUIN LOCAL HEALTH- DISTRICT E. H. 9 1-'68 Rev. 5M• -" .�-