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Apartment House E) Commercial []Trailer Court Residence <br />... <br />01 <br />LEACHING LINE t ] No. of Lines Length of each line Total Length <br />'D Box .... Type Filter Material Depth Filter Material <br />Distance to nearest: Well Foundation Property Line <br />Depth ,. ..., ..... Diameter Number Rock Filled Yes 0 <br />Water Table Depth Rock Size <br />Distance to nearest: Well Foundation Prop. Line <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date 1 <br />Septic Tank (Specify Requirements) .... <br />(Disposal Field iSpecify Requirements) <br />I/P.1 ,6411.41 __,Alefeve.. .5:4- <br />Final Inspection by: .. Date ' 7/ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicote) <br />This Permit Expires 1 Year From Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br />described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />Permit No. <br />Date Issued <br />JOB ADDRESS/L I N <br />Owner's Name <br />Address .. tr. <br />Contractor's Name <br />Installation will serve: <br />ge CENSUS TRACT <br /> Phone <br /> City <br /> <br />4: License # ?Phone <br />Motel 0 Other <br />Number of living units- Number_of bedrooms .3 Garbage Grinder Lot Size <br />Water Supply: Public System and name <br /> Private <br />Character <br />- <br />Character of soil to a depth of 3 feet: Sand lil Silt 0 Clay 0 Peat 0 Sandy Loam Clay Loam 0 <br />Hardpan 0 . Adobe 0 Fill Material . If yes, type <br />(Plot plan, showing size of lot, location of system in <br />NEW INSTALLATION: (No septic tank or seepage pit <br />PACKAGE TREATMENT [ SEPTIC TANK [ ) <br />(Draw existing and required addition on reverse side) <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br />sed agents signature certifies the following: <br />"I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br />as to become subject to Workman's Co nsation laws of California." <br />Capacity Type <br />Distance to nearest: Well <br />relation to wells, buildings, etc. must be placed on reverse side.) <br />permitted if public sewer is available within 200 feet,) <br />Size Liquid Depth <br /> Material No. Compartments <br />Foundation Prop. Line <br />SEEPAGE PIT r <br />No 0 <br />to <br />v2_ <br /> FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY .-'"4-2-4.-i-e-.01-e DATE i - - .2-- <br />BUILDING PERMIT ISSUED DATE \ <br />ADDITIONAL COMMENTS .,. <br />1-'68 Rev. 5M <br />"\. <br />2. H. 9 <br />FOR OFFICE USE: <br />Signed <br />By <br />(If other than owner) <br />_ Owner