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FOR OFFICE USE: 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 application is mar de in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION /711e---,. /__- � .9r / CENSUS TRACT _-s _Y.7 4 Owner's Name17- -/ ,7`Xe -- - -- ` --/-- - -----Phone ------------------ Address -- -- ----------Address 0 - cityeL� t Contractor's Name .- __-- '_ tE[ _ � ------------------------------ ---.License # L� - P one Installation will serve: Residence;WApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number ------------------- --- - -- Number of living units:-._ --_- Number of bedrooms ------Garbage Grinder ------------ Lot Size ...z"o- C/_,e_.S Water Supply: Public System and name ------------------------------ Private Character of soil to a depth of 3 feet : Sand❑ Silt F Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .[ i Hardpan Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot ------------------_(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 f ] SEPTIC TANK ---_--__ Liquid Depth _------------------------ [ ) Size �i �,r/ Capacity - ------------------ T ------ No. Compartments --------------- Distance --------- 57� �l Type Material ----. Distance to nearest: Well ------------------------------.-----Foundation ---------------------- Prop. Line ---.-------------•----JLEACHING LINE [ ) No. of Lines _--.------_-_-.-_ --.-- Length of each line---__---------------_.___- Tota! LengthJ— -------------•-------------.1 �)CtS��rf D' Box _-- -------- Type Filter Material _------------------Depth Filter Material --___--_-_- Distance to nearest: Well ----------------- ------ Foundation ------------------------ Property Line --------- SEEPAGE PIT [ ] Depth -- �---- Diameter _15;eL'---- Number ------------------ Rock Filled Yes No .C] Wafter Table Depth --------642--r -----------------_--Rock Size 'Distance to nearest: Well --- 0 f -_--_-__,Foundation --- ----------•-•-- --�Q-----•-'-- Prop. line ----� -.- REPAIR/ADDITION(Prev. Sanitation)Permit# -------------------------------------------- Date .-_---- _---------__-- ) - ---------- Septic Tank (Specify Requirements) -- -------------------------------------------------------------------------------- jT,%p1 al Field (Specify Requirements) _ _ l , - ---------- f . " `7 --------- -- ------ ----------------- f . r-- ------------------------------ x- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this app) on`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 lett to Workman's' ompe ati.on laws of California." Signed -_.. _ - _ Owner - - ----- - - --------- - -- ------- ---- BY - �G._ --- Title , I other than o ner] I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - - --- --�------ - ---------- -- --------- DATE�-� ---�-7-�"J�----------- - BUILDING PERMIT ISSUED -------------- ---- --- ------------------ DATE -------------- - T10NAL COMMENTS ------------- --------- ---------- - --------- I --------------------- - --- - ------ -------------------------- - ----------------------------------------------------------------- - Final Inspection by: -__---- -Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M