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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- - (Complete in Triplicate) Permit No. --'_- This Permit Expires 1 Year From Date Issued Date Issued ._--l___"_ 'r!� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is Made in compliance with Coun y Ord* ance No. 549 and existing Mules artd�eguiations: JOB ADDRESS/LOC N . _ �,- -------- .`__�� -------__CENSUS TRA T ___ Owner's Name - � ............ ' ------Phone ---------------------- { .� ' p� Address =_ = p - - -- _. City Contractor s6ime -------- -------- � - '—�- -J-- _,.License # ��`�'�Phone ------------------------•-•--- Installation will serve: Residence.❑A' partment House 1❑ Commer 'al :[:]Trailer Court !E]G - s1 Motel ❑Other - -- ----- --- - _- +� I , Number of living units_____________ Number of bedrooms ___RGarbage Grinder ____________ LotrSize ___:____ ---- ________ _ � 4 Water Supply: Public System and nam_ a __________________________ :_ `'` __Private L Character ofsoilto a depth of 3 feet: Sand'❑ ❑ Clay s.❑ Peat ❑ Sandy Loam [] Clay Loam .❑ Hardpan , Adobe'❑ ]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.) rV NEW INSTALLATION: (No septic tank or see `e pit,permitted ublic sewer is available within 200 feet,) fr` PACKAGE.TREATMENT [ SEPTIC TAN ' 't-- `t--�_- Siz -- --------------------- x - ' Liquid Depth ---�-------------.--._.. Capacity _ -------- � ,ype _ _ Peso Materia - .ac_Q-;____ No. Compartments Vr W #, , stance to near Well---- __~-~Si-Y~--=_-_-----_Foundation -_la---________ Prop. Line ---------------------- LEACHING LINE [ No_ of Lines __.--__ '_—__=t LengtFrf each line----- ---------------- Total LengthC�� f --- - ----------------- D' Box ______ Type Filter Material ---- Depth Filter Material -___ __ r Distance #o eares#: Well _._- 4�_______lFoundation ________i_0_-f__.___ Property Line t � SEEPAGE PIT Depth S__�_____ Diameter _ ��__! Number __._____��_________________ Rock Filled Yes -' Nc Q] ,.- Water Table Depth -----------------d0----_---.----L -------Rock Size __!�-_•f ----•---- Distance to nearest: Well -____ Oo - ` ______Foundation a ` rs' I ---- --------------------- . ---------------•---- Prop. Littre -.----••------ REPAIR/Al ------•-•---- " . REPAIR/ADDITION(Prev. Sanitation Permit# ---------- t___;___ Date _________________________________ ) w- Septic Tarik {Specify Requirements) --- ------------------•-----•------------------=_--- --------------- Disposal Field {Specify Requirements) __________ _ ~ff/ t{ ( 'l i ! ----------------------------------- - - - - - - - ------------------------------------------------------------------- (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 -ch this perrnit'is,issued, I shall not employ any person in such manner i as to become subject Wo man's Co sati n.la s,of.California." Signed t -- --------2--------- - -----E ------ - i -- _ Owner ---•- --- -�BY t - ? Title ---- _e_� I Z_ _1----------------------- -------- -(If ofh- an ow`ne )'i' `r FOR DEPARTMENT USE ONLY APPLICATION] ACCEPTED BY ` ------ - - DATE ---------------------------------- BUILDING v b BUILDING PERMIT ISSUED ------------------------------------- ----------- •------- -- --- -•- ----- - -------------------DATE --------------- ---- --- ar •----_--- ADDITIONALCOMMENTS ------------------------------------------------------------- --------------------------------------- ---------------- ------------------------------------------------ x Final Inspection by: Date - - �:` °. SAN JOAQUIN LOCAL HEALTH DISTRICT :: E. H. 9 1-'68 Rev`5M.