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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. L --- - ---- - --- ----- (Complete in Triplicate) _ Date Issued This Permit Expires I Year From Date Issued [L Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein L described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _r - CENSUS TRACT __.._a. SZ JOB ADDRESS/LOCATION _ �'- —---------`------------------ - �- - - - Owner's Nam(es ...,.. qq� a Phone 41 �f - - .----------------------- City Address ..I� --I ------ t e- ( Contractor's Name -- h ----- ------------------------------------------- License # Phone - . ....... .......---. L Installation will serve: Residence (Apartment House❑ Commercial❑Trailer Court Motel ❑Other Number of living units:_-_ ---_ Number of bedrooms ..---------.Garbage Grinder ------------ Lot Size ----..---_.___-_`r_--_-._..-__--.._-. LWater Supply: Public System and name ---------------------- ------ . ------------------ - -------------------------------Private Character of soil to a depth of 3 feet: Sand X Sil% Clay ❑ Peat[I Sandy Loam ❑ Clay Loam E)L Hardpan ❑ Adobe❑ Fill Material ___ -_ - If yes,type ------ --- __.--_-__- (Plot plan, showing size of lot, location of system i relation To wells, buildings, etc. must be placed on reverse side.) LNEW INSTALLATION: (No septic tank or seep pit permitted if public sewer is available within 200 feet,) t�� r c tY PACKAGE TREATMENT [ ] SEPTIC TANK [ Size---_--_E.. w_-. Alm-_..._-.- Liquid Depth ...-_L_....._..-____.. ),J Caps ity 3f'yIOX S Type f�OVf; Material No. Compartments _____.1. stance to nearest: Well _-_1 0------F7. ..----Foundation ----- ---------- Prop. Line ___ .......... N LEACHING LINE No. of Lines -------- ---------- Length of®each line.__.-�-C`_-.___-_ Total Length ___.. _-_._--. 'D' Box/*5.- Type Filter Material _,800'- Depth Filter Material ------ ter...___-.---------------------- Distance to nearest: Well ------------------------ Foundation -.--------__ ---------- Property Line ........................ 1 SEEPAGE PIT [ j Depth -------------------- Diameter ----- .......... Number --------------------- ----.. Rock Filled Yes ❑ No [] L -� Water Table Depth -----------------_-_ --------------.....Rock Size -------------------------------- Distance ----------------------------Distance to nearest: Well ----------------...........-------------Foundation ------------ ....... Prop. Line ------_-...______---- 9� j REPAIR/ADDIT.ION(Prev. Sanitation Permit# --------------------.----------------------- Date ----------- --_...._-_.____._.) {` Septic Tank (Specify Requirements) --------- ------ ------------------ ----.. ................. -----------------y--------.e---.---.--------- --------------------- Disposal Field (Specify Requirements) ._-.-_--__ -_F. -..-Cr _-_--__ _ :........_.._._1_._--__.___WiQL L ---------------. ----------------- -------.------- ---- ---. .. --.- ----- ---------- ---------- --- ------------- -- ---- ---- (Draw existing and required addition on reverse side) L1 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 foil wing: Lcertify that in t e performance f t e work for which this permit is issued, I shall not employ any person in such manner as to becom u IecT to W n's o�ttpens n laws of California:' Signed -- 7!�7� n's Owner LBy --------------(If oth.er- than- - -owner)----------- - ...-.. Title ... _..... ..... - -- ... -- -- ------------------- FOR DEPARTMENT USE ONLY L APPLICATION ACCEPTED BY - T 7 -------------------------- -- -- DATE BUILDING PERMIT ISSUED .-------- --------- -------- ---------------------------------------------------------------DATE --- -------- --- ------------------- ADDITIONALCOMMENTS --------- ------ ------- . ---- --- . --- ---- --- ------- --- ---- - ---- ._-----...-------------------------------- - L ...-- ----------- -- ---- - --- ----------------------------------------- - fJ - ---�--_-S---- _ Final Inspection y: _ Date /�r �".� . . - LSAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M