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FOR OFFICE USE: ~ ______________ APPLICATION POR SANITATION PERMIT (Complete in Tplicate] Permit No. ri ---------=-- ------------------------------------------- Th'ss 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 compliance with County rrdinonce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ----------- ,--____ r ------ ------ y- -CENSUS TRACT -----------------------=- Owner's Name -------------- // - - ------ - ------ Phone' -T i1- City --' -- - Address --------------------- JSI- PhoneContractor's Name ----- : Installation will serve: Residence Apartment House-E-] Commercial :❑Trailer Court i❑ . Motel ❑ Other ------------------------------ ------------- / p I Number of living units:....../---- Number of bedrooms ----3----Garbage Gr' er .-----_-y-- Lot Size 1-31-- ----9- _ Water Supply: Public System and name ----------------------•------------------------------ - - ----------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam :0 Hardpan ❑ Adobe Fill Material ------------ if yes,type ---------------------------- (Plot plan, showing size of lot, location of system irelation~to-wells b-buildings etc.must-be placed on reverse side.) \� NEW INSTALLATION: (No septic tank or seepage p t permitted if public sewer is available within 200 feet,) c/ --'----- --- � " ' PACKAG.E�REATMENT � �.�SEP_TI.0 TANK:, __,�,�, ize__-- �,,7 �- �' --- Lic�uid_Depth Capacity!-/w - Type Compartments —°``2 r� Distance to ne rest: Well _____ --------------_-Foundation _----f_Q-..- Prop. Line _--, _--_-_...... I p � LEACHING LIN n �NO. of Line �-- -----_ Length of each .line----g�---_-.._-.-- Tot i Length 47+Q.__._- _ 'D Box ---- Ty'e Filter Material= -` Depth Filter Material -------- - Distance to nearest: Well ____ _____________t'- Foundation.» �}`..=-_�Pr perty% Line. . _. SEEPAGE PIT D th___2_,� �_____-Diameter __Y,j--_--_ Number --------_ / /--- -- 4ockk Fille Yes .-lal- . Water Table Depth ' ------ J �.t Rock Size(-L�i-�- - i ;� )stance to nearest: Well ____ �-----------------------------Foundation __/..0_ _!__'s- PF70W Line -_.,--__.-_--_._ <..t P REPAIR/ADDITION(Prev. Sanitation Permit# ________ ______S_ ------------------ Date ----------- �. mi ��'[ 1 Septic Tank (Specify Requireents) -___ ------------------ .--_---. -_- ------ " - — �. _ Disposal Field (Specjfy Requirements) �" -= ti - =--- - -- ---------------------------- ----•------------------`----_------------------------------------------------------------------------------------ (Drq. +j -xisting and 6cluired a`daition on reverse side) I hereby certify that I have preparedthis application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, a4litules 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 subject to Workman's Compensation-laws of California." Y Signed ----41f ---------------- --- ----------------------------- Owner -------- ---`-.-- --- ---------------------------- Title _ /-------------------------------------------- - other n owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = - -------------------------------------------------------------------- DATE ----- BUILDING PERMIT ISSUED .-- DATE -------------------------------------------" ADDITIONAL COMMENTS . '° + "" ' e ' --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- - --------------- ----------------- --------------- ------- --------------------------------------------------- ---------------------- - ---- --------------------- ------------------ -- 7-6 �' -- --- ------- --- ------------------------------------------------------------------------------------------- Final Inspection by �' + Date--------------------------------------------------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT ! E. H. 9 1-'68 Rev. 5M