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FOR OFFICE USE: APPLICATION FOR- SANITATION PERMIT ------------" ------------ ------ --- T/ -lam/ (Complete in Triplicate) Permit No- ---------------------- ------------------------ This Permit Expires I Year From Date Issued Date Issued i 1r 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 existing Rules and Regulations: JOB ADDRESS/LOCATION -- - --i��----, (?''-- ` ----- -------------- --- ---------CENSUS TRACT _' Owner's Name `` //' --l---------------------------- --------- Address ... ------ ----- ----- hone ------- -�------ - city i _Contractor's Name .. __ .�. ' --' � -`��---------- ------------- ------ License.# J;�_ ��--- � ----------- -- -- ®" Phone %��?- -- Installation will serve. Residence XApartment House❑ Commercial []Trailer Court ;❑ Motel ❑Other ------------------ Number of living units:---/----- Number of bedrooms �� _ __ __Garbage GrinderA/e__- Lot Size ,f S`��`�---------------- F + Water SuPPIY Public System and name- ?__- - ---------- ------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ' Fill Material ------------ If yes, type ____________________________ { (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 publie.sewer is available within 200 feet,) `, V ` PACKAGE TREATMENT [ ] SEPTIC TANK r� Size.-. �u ��---��-i ------------------- Liquid Depth- - Capacity ' TYp - f - ------------.---=` � - -- ✓_ Material-f_414-__---- No. Compartments ` -_______________ y Distance to nearest: Well _____ ---------- -------Foundation -4.5-f- _----__- Prop. Line . - ------ _ LEACHING LINE No. of Lines ______ ( �`------------- Length of each line-- L�----------------- Total Length ------- 'D' Box)/X- Type Filter Material/ 6r/ 1Depth Filter Material 1101" __-.-_____.---_ ------•-__--- Distance to nearest: Well% __________ Foundation _'_____ Property Line. --------•-----•--•--•--- SEEPAGE PIT [f} Depth __ -s -___ Diameter : _ _- Number ---- -------._-------- Rock Filled YesA No fl Water Table Depth -- } = -------------------------Rock [ roe Distance to nearest: Well -------__ -------------Foundation _rl---------- Prop. Line _.07-----_--_ REPAIR/ADDITION(Prev. Sanitation Permit# --------------- -- —r----------------- Date --------.-------------------------} r Septic Tank (Specify Requirements) ) -------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- F ---------------------------------------- - ------------------------------- -------------------------------------------------------------- - ' - ---------------------------- raw existing and required addition on reverse side) i I 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 following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner ' as to become subject to Workman's: Compensation laws of California." Signed - Owner I i BY ------------- -------- ;Z�2 ---------------------------------- Title F .._ ?� �.. (I her than owner) FOR DEPARTMENT USE ONLY F, APPLICATION ACCEPTED BY__/ DATE 7� BUILDING PERMIT ISSUED -------------------------------- ------------------------------------------------------------DATE - - -- -- ADDiTIONAL COMMENTS ------- --------------------------- = ------------------------------------------------------------------------------------------- ---------------------------- ------------------- M -------- --- --------- -- --- -------- --------------- - - - Final Inspection b r P y Dat 3 ----- j_ F SAN JOAQ IN LOCAL HEALTH DISTRICT ';y i E. H. 9 1•'68 Rev. 5M i