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FOR OFFICE USE: PLICATION FOR SANITATION PERI ------------- -- --------------- Permit No. (Complete in Triplicate) - Date Issued -_-----_---- --- - _-_-----------------------------" This Permit Expires t Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereir described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._._�fftt -_ ---". '---- CENSUS TRACT _. g Owner's Name -- � fit * Pl - ------------------Pho e S39 Address ��-�-��-�---------�--'----��----�--�l/�(�_(��.1 L---------..._:City =-_ ----==-=--- Contractor's Name ----0.1111 .P_l------------`- --- --License # ------- ---- -- ---- Phone ..---------------------------- Installation will serve: Residence partment House Commercial❑Trailer Court .❑ Motel ❑ Other ---------------------------------'---------- Number of living units: ---------- Number of bedrooms ............Garbage Grinder ------------ Lot Size __._.___.-__-..___...__.-.-____.---_---- Water Supply: 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-Ma-terial -----------. 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 &ze-------t___:_____................:..::,_.•_._.,_ Liquid Depth -----------_________._--_- Capacity - ------- - Type ---------- Material = = No. Co partments -------------•-------- Distance to nearest: Well - -- --- - ----------- --------Foundation -_ -----.--- ----- -- Prop. Line --________________-__- Len t of each line __ - - _-_- Total Length ....._---___________________ LEACHING LINE [ ] No. of Lines -.. _-- 9 D' Box Type Filter Mater i I -. -------Depth Filter Material ----------------------------- Distance to nearest: Well _-- Foundation Pr perty Line --------- - ----- Diameter ----- ---------- Number . --- .----- --- ---- Ro k Filled Yes 0 No C3 SEEPAGE PIT [ ] Depth - - � Water Table Depth -- ---- Rock Size - Pro Line ----•-•••--. ` Ll -- Distance to nearest: Well --------..:. .:. ...__---------------Foundation __-.__ ._.- . -- P ` ----- -- .- '- - Date - ----------------- Septic --------------- ) REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------ r Se tic Tank (Specify Requirements) ----•'- --•--- ---------------- Disposal Field (Specify Requirements) .-_.___ ---- -- ---------------- --- - ------------------------- - - -- - - -------- - ' - -------- - - - - ------- - - -- - (Draw existing and required addition on reverse s d e hat 'the work will e done in ce uin I hereby certify that I have Laws, ared this and Rules andcation and Regulations tof the San Joaquin Local Health District. Home with owner or lcen- County Ordinances, State Laws, sed agents signature certifies the following: "I certify hat in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to b c subject to an's Compensation laws of California.,, Signed - ---------- --•----•---- Owner / .:P- Title ------ --- - --- ---------- ------- ----------- - ..---------- BY - - - - ---- ----------------'------ ' (If other than owner) FOR DEPARTMENT USE ONLY ' {J DATE ---'--- ��- ---�-� ---------- APPLICATION ACCEPTED BY _- .T 4 BUILDING PERMIT ISSUED ------............. -"I.----- -..._._DATE _ - - -----•------- ADDITIONAL COMMENTS -— --------------_-----------11--7, ------ •------- ------------------------------ - ----•-_._..---- - - --- '---••------ -.-. .----- - -'-- - �- ---- -------- ------ -- a -- Final Inspectio SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M