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FOR GFFICE USE: - ' APPLICATION FOR SANITATION PERMIT .. . . . ...... .... ---- / --- --- - --- ---_. _... (Complete in Triplicate) 4[•\ - it No, __---.......... This Permit Expires lYear From Date lssu i issued ./Q'1- -{t?7 \pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein `.lescribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -_- rt---:- ---_-:....._t_J: _1_S__1_,1.1_._]-, t.:::,.__---- - --__---_CENSUS TRACT .......... 1-- _----- Owner's Name Pu........ _ ------ --------&_ ,__ jj�['--- ----------------Phone ............................... Address ....j .... "- - -- -- Contractor's Name ,-...... -............................ ........•------._License # ..._........ ........ Phone ...-..------------.-......... Installation will serve: Residence 0 Apartment House F] Commercial []Trailer Court ❑ Motel ❑Other ....... of living units: ._._ Number of bedrooms _.£_::...__Garbage Grinder ./SL i__.._ Lot Size -._ ................ Water Supply: Public System and name - --------- ---------------------•__-_--------------•----------------------------------- ---------Private E] Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 .Hardpan ❑ Adobe❑ Fill Material _t_(_,___ 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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK 4 ] Size-----------------------------------------------_ Liquid Depth ----- ------- V Capacity - - ------------ -- Type ---------.......--_ Material.... -------------_ No. Compartments ................ 0 Distance to nearest: Well --------- -------___-__---Foundation ----- ----------..--_ Prop. Line --- -----.. - Cn LEACHING LINE [ ] No. of Lines ----_-__------------ Length of each line----- _-------------------- Total Length 'D' Box ------------ Type Filter Material ----------------.....Depth Filter Material Distance to nearest: Well ......... -._._-__ Foundation ........ Property Line ..........-____-------- SEEPAGE PIT [ ] Depth -----------__ Diameter ----------- Number ------------------ Rock Filled Yes ❑ No ❑ Water Table Depth -------------- - --------------__---Rock Size ---------- .............. ...... Distance to nearest: Well _-_._.--.___-.-------_--------Foundation ------------------- Prop. Line ----- ----_---------- REPAIR/ADDITION(Prev- Sanitation Permit# -------------------- -------------------- Date --------- --I Septic Thnk (Specify Requirements) ----- '`------- 'k' ----------- --------------------- --------- Disposal Field (Specify Requirements) -----�1=r-:---L -••--- ak r x-a- ---d•.t-Il T-_-- -_- x 1 z� _ • _ ----------- ----------�-)-.1--- ------------- - ----------"-- -- .--. .... --.-----••--••---••-•------•--. ------------------------- --_-_........ -------------------.-------.._..._..J.-.--------_.-..-..._._.---------------.-.--- . ------------_ ....._._.{.....____...___..___.----- • (Draw existing and required addition on reverse side) 1 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 r orm ^^ce of the work for which this permit is issued, i shall not employ any person in such manner as to becoubjSctJWorllman's Compensation laws of California." Signed ---------------------------------... �,.7.. iJ.S _... .... Owner By _ --------- -- -- ---- ` -' Jitle - - -------------- ----- (If other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .q - ---------- DATE { .._ /. _- BUILDING PERMIT ISSUED .. --- _ _ DATE ADDITIONAL COMMENTS `-..-- cove t7cJr s Final Jnq3Vt:*s r- — - --------------------------_ Date ..lf -` SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M .