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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------ (Complete in Tri licate) P -------------------------------------------- - P Date Issued _. ".3_._7-1! This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT -------------------------- JOB ADDRESSAOCATION -e. -� ------ -�-- -- ----------Phone ------------------------------------ Owner's Name ------ r Address Cit --------- _ ----- - ---- ---- - ---------------- ----- ------ - -- P -`�_.Li erase # �t ` hone ------------------------------ --Contractor's Name -- r.;:�;�, Installation will serve: -Residence-m Apartment-House El-Cori mercial-:❑Trailer-Court--,,[]---- Motel ❑ Other ------------------------------------------- Number of living units:,----/----- Number of bedrooms __4------ Grinder -___.__-.__ Lot Size _.-___"__________ -".---•. 4- Water Supply: Public System and name ---------------------------------_--------- --------- --------- ------------------------------•------------Private�[ Character of soil to a depth of 3 feet: Sand'[] Silt Clay ❑ Peat❑ Sandy Loam( Clay Loam 'E] terial ------------ If.yes,type __------- Hardpan F-] Adobe ❑ Fill Ma (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,} I . Nw� ��moi_ PACKAGE TREATMENT [ SEPTIC TANK;[] k Size------------------------------------------------ Liquid Depth ----------------• capacity ---- ---------- - Type ------------------ -- t Material------ -------------- No. Compartments ------•-------- ------- Distance to nearest�1W11 """-- ----=-= ----------"--------Foundation ---------------------- Prop. Line ------..-.------------ - LEACHING LINE [ I No. of Lines ---------- Leng' ------- Total Length ---------------------------- __LL�_---� „ th of each line__._._"_-._____- -- g _.De ----------------- ----------•----- 'D' Box .__--__-__ Type Filter Material -_-__------ Depth Filter Material I ------- Foundation Property ------------------------ Distance to nearest: Well __________ - -----�---- ---------- -" SEEPAGE P17 [ ] Depth Diameter Number ___---_.____._--________. Rock Filled Ak Yes [] No i❑ VA Rock Size Water Table Depth -------------------------------------- -------------- � %� 1 { :f:°.Foundation ----- --------------- Prop. Line ---------------------- Distane,to nearest: Well _________________________ , .------- REPAIR/ADDITION(Prev, Sanitation Permit C# ------------------------------- --"------- . Date ---------•'--- - -- - - } Septic Tank (Specify_Requireryip. - _------_ -------- = -=------------------------ .:� - ------ sal - - �- s Field (Specify Requirements) _ � -/ - I't r`a-P-p - - " - -- -------------nom.- ---- ------ f '2 -------------------------------- ------- -- - - --- ---- ----- - --- - - - Draw a ' ting and required addition on reverse side) I hereby certify that I 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 - ---------- - --- fTitle ----------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------'-------- - -- --------- ------------------------•-------------------------------- ------- DATE - z7- � -- - BUILDING PERMIT ISSUED --------:-------- ---------- ----------------------------------------- -----------------------------------DAT ------------------------- ------ -------- - ADDITIONAL COMMENTS --------------------------- - - - -- -------- -----""- - --------------------- --------------- ------- ----------- ---------------------- ------------------- --- --------------------------------------- - ----- -- - - --- -- --- - ------- Date Final Inspection by C' ' --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ;