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FOR OFFICE tiSE; APPLICATION.FOR SANITATION PERMIT t% 4 . / s .--„�rplete Permit o. &in Triplicate] ------------------------------ This Permit Expires 1 Year From Date Issued Date Issued _-5 -- � Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _ - JOB ADDRESS/L%CATIOINJ ` t1` �----. �-- -- -----------------------------------------CENSUS TRACT ---5 Y JOB ADDRESS/L Owner's Name ------ - ------------------------------------------------------------- --- --Phone ------------------------------------ Address --- ------ ----------------------------- City_ a Contractor's Name ___ __ License # ”}Q2.3`i---- Phone Installation will serve: Residence [ Apartment House❑ Commercial :❑Trailer Court ff Motel ❑Other -------------------------------------------- Number of living units:....l------- Number of bedrooms _._'�?------Garbage Grinder -------- Lot Size ----------------_--_____----_-_--------__ Water Supply: Public System and name ----------------------------------------------------------------------------------------------- --------------Private CI Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam P 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT X SEPTIC TANK' Size - Liquid Depth -- Capacity 1;(6-X)------ Type ;;�!-4-5------ Materia -__- -__ _ No. Compartments . .. , Distance to nearest: Well ---6_0 - ------- -- ----Foundation A-0 Prop. Line __ -4--------------- LEACHING LINE No. of Lines _-A---------------- Length of each line-�-�---------_-.____-- Total Length -C�Q._....._.--._--- Q } I( it 'D' Box ----t_-_- Type Filter MateriaL? l -- ---c1_'��CLDepth Filter Material �a,_-- __----_i---------------------- qq ! Distance to nearest: Well _I_ _`_____________ Foundation .sem-p--------------- Property Line -_!__cl /_._______..__.__ SEEPAGE PIT T Depth lo�__________ ___ Diameter __y_ f ------ Number -- Rock Filled Yes M No ❑ Water Table Depth ------------------------------------------------Rock Size w� �} ----------------- Distance to nearest: Well __ _Q-d_--_------------------------Foundation ------ Prop. Line -1-(3_.-_._--.--_--_ REPAIR/ADDITION(Prev. Sanitation Permit*# -------------------------------------------- Date ---------------------.------------ Septic _--- __---Septic Tank (Specify Requirements) ---------------------------------------------------- ---_------------------ Disposal Field (Specify Requirements) ----------- ---------------------------------------------------------------------------------------•--------------- ----- -------- ------ -- -------------- -- - -------- -------------------------------------------------------------------------------------------- (Draw existing 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 Y1 ___ - -- -- ------------------------------ (If other Vit/ Titl (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --�R`a------------------------------------------------------------------------------ DATE ------ . ----------- BUILDING PERMIT ISSUED ---------------- -------DATE ------------------------------------- -- ------------------------------------------------------------------------- -- - ADDITIONALCOMMENTS ---- ------- - ---------------------------------------------------------------- -------------------------------------- --------- -----------------------.--- - --------- -------------------------------------------------------------------------- ---- -----1 ---- --------- __. Date - - Final I ection b- _" f l - --3a_ /___ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ti