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" OR OFFICE USE: (7) APPLICATION FOR SANITATION `MIT Permit No. ..7t.-'._ .d --------- --------- ------------ -------------------- (Complete in Triplicate) -------------- --------------------- Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein iance with County Ordinance No. 549 and existing R es and Regulations: described. This application is made in compl JOB ADQRESS/LOCATION ...l.��-� C�7 :-1 -r / ':f'' �/L'Cf�.�...L.- ENS` RACT Owner's Name , '--I ��i - - Phone C1 r''� n Z - Address _... .�] Q yLicense #/�z. • f �'--- Ph oneL�!�y Contractor's NameL ��7 Installation will serve: Residence;Apartment House❑ Commercial {]Trailer Court C] Motel i�}Other ------------------------ •------ Number of living units:....[----- Number of bedrooms 2---____Garbage Grinder .}� -: - Lot Sizef -'----------- i Water Supply: Public System and name ---------------- ---------------`------•--------••--------------•------------Private$) 1 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam t Hardpan$ Adobe 0 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 public sewer is available within 200 feet,) G PACKAGE TREATMENT [ SEPTIC TANK;` Size-�X' ?_-,1 --�-r--------- Liquid Depth . ................... C Ca pacit / Type r�� _ Material ,1.ex----- No. Compartments ... --........:.... y Distance to nearest: Well ---------------_----Foundation _0- _._._-- Prop. Line 9-Q-- ..--.... I LEACHING LINE No. of Lines _.., -- Length of each line.%�/C- Total Lengfih .�G�- ------ 'D' Box y6_?.�__ Type Filter Material/—'- U yDepth Filter Material/, k--_ ----_----I....................... Distance to nearest: Well 160 ----- Foundation s - ----------- Property Line. ......... SEEPAGE PIT jjLJ Depth __ ,�_- -.-.. Diameter ��_. Number _1Z--------------------- Stock Filled YesN No i❑ i Water Table Depth .. Rock Size/"'-_. -.-.-----•--•---- 1 Q Distance to nearest: Well _____________•--------•Foundation ---% _ --------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- Date -------------------- •------------) Septic Tank (Specify Requirements) ---- ------------— Disposal Field {Specify Requirements) ------------ -- -------------------------------------•---------------------------------- I t -------------------------------------------------------------•------------------•-- --------- --------------------- ------ ----------- - ------------------ - ------- (Draw existing and required addition on reverse side) I hereby certify that 1 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- -------------------- -- ------------------------ -------------------------------------- Owner BY --------------------- --- ---- ------------------------- ------------------ Title (If other than owner) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE --- ---------- -- --------- =----------------- --------------------- BUILDING PERMIT ISSUED ------------- ---------- ------------ -------DATE -------------•-•------------------------••- ADDITIONALCOMMENTS ---- ----------------------- -•------- - -------------- ---------------------- ---- ------------------ ------ ------------ ----------------------- --------------- - ------- -------- ------------------------ --- -- ----- Final Inspection b pate ................ -.t4`_ .._...__... r SAN JOAQUIN LOCAL HEALTH DISTRICT ( E. H. 9 1-'68 Rev. 5M