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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <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 a Id install the work herein <br />described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />CENSUS TRACT . ............. <br /> P lone <br />Contractor's Name <br />Installation will serve: Residence Apartment House 0 Commercial I:Trailer Court C <br />Motel 0 Other <br />Number of living units. I Number of bedrooms Garbage Grinder Lot Size <br />Water Supply: Supply: Public System and name Private, <br />Character of soil to a depth of 3 feet: Sand t: Silt 0 Clay D Peat 0 Sandy Loam 0 Clay Loam Te <br />Hardpan 0 Adobe 0 Fill Material If yes, type <br />of system in relation to wells, buildings, etc. must be placed on reverse side.) <br />r seepage pit permitted if public sewer is available wi bin 200 feet,) <br />K( ) <br /> Size Liquid Depth <br /> Type Material No. Cbmpartments <br />Distance to nearest: Well Foundation Prop. Line <br />LEACHING LINE t) No. of Lines Length of each line Tote) Length <br />'D Box Type Filter Material . Depth Filter Material <br />Distance to nearest: Well Foundation P-operty Line. <br />SEEPAGE PIT [ I Depth Diameter Number Rock Filled Yes 0 No i0 <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 Fie d (Specify Re uirement <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- I hereby certify that I have prepared this application and that the work will be done in cn cordance with San Joaquin <br />/2_. a 0 <br />aw existing and equire d addition on reverse side) 1-1A- X •-,11--W--12--1,21, <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 ernplow any person in such manner <br />as to become ct to Workman's Compensation laws of California." <br />Permit No. <br />Date Issued --/7-6 <br />JOB ADDRESS/LOCATIONa/247_‘- <br />Owner's Name <br />Address ........ a7.17.7.0. City <br />41---Ase 4.License . Phone <br />(Plot plan, showing size of lot, location <br />NEW INSTALLATION: <br />PACKAGE TREATMENT <br />(No septic tank <br />[ ] SEPTIC TA <br />Capacity <br />Signed <br />By <br />(If other than owner) <br /> Owner <br /> Title <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY .//7 DA-E 6 Yell'-e 7 <br />BUILDING PERMIT ISSUED DA-E <br />ADDITIONAL COMMENTS <br />Final Inspection by: Dale ‘-ii-41 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H, 9 1-'68 Rev. 5M