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FOR FFICE USE: t APPLICATION FOR SANITATION PERMIT `- (Complete in Triplicate) -Permit No: :_7_Z' J-4 This Permit,,Expires 1 Yeaf From bate Issued Rafe Issued Application is hereby made to th San Joaquin Local Health District for a 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: JOB ADDRESS/LOCATION ----- (-,/-----C-</- ---- -- ,-------CENSUS TRACT --------------•:---------- ` ro �� Owner's Name i -------- —Y Phone -- --_- , It Address ------ 7-4ire-� �I �'�? ---- -__- --� . City n 3 Contractor's Name _. -_ .-__.��{ __-____ __ f ------------------License # c+ ,. 1 _ Phone / _ 1-7 Installation will serve: Residence ❑ Apartment House❑ CommercialfikTrailer Court ',❑ t Mate! F1 Other - ------------------------------------------ Number of living units_____________ Number of bedro ms ' _ ____Garbage nnder��-:_ Lot Size __ .___ ____�_-� -----_-.-__-- a Water Supply: Public System and name --------- -------- 4 pp Y t Y ( -------- --------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ . ,Silt,:o _ Clay P.,....Peat❑ Sandy Loam ❑,.,-,rClay Loam❑ f 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 TREATMENTj �SEPTIC TANK, -�*5 f f. `-- ' p ( 7 Size--------------------------- - - ---- Liquid Depth --------------------------- # Capacity ------------------ Type -------------------- Material-- - ------ No. Compartments ---------------------- a }Distance to nearest: Well ------------------ - ------------.{_Foundation - -------------------- Prop. Line --_--------------_---- LEACHING LINE, %S�f o L�Tnes ________________________ Length of etch line-------------------.- ______ Total Length ,_____..____-__ 'D' Box __-1_-.------ Type Filter Material ---------------------Depth Filter Materia! ____________________________________________ - Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ---------------A ________�_`____.:.___ SEEPAGE PIT' X Depth o ti�---/___:__ Diameter _.,S______-__ Number ___._.__._`_____________ Rock Filled Ye�No 0 6. t . . Water Table Depth --------7 --------------------------------Rock Size -------------------------------- R Distance to nearest: Well ----- fi_'__________________Foundation _��1 _ _ Prop. Line ---- ---------- ti REPAIR/ADDITION(Prev. Sanitation-Permit# -------------------------------------------- Date ------- --------------------.-----) Septic Tank (Specify Requirements) ------- ------------------------------------------------ ----- --------------- ri. ; A Disposal Field (Specify Requirements) ------ - ` mac------- .— ---- ---- - ----------- a --- ------=------------------------------------------------------------------------ ----- -------------_------------------__---_------------------ r (Draw existing and required addition on reverse side) I hereby certify that I have prepared this sapplication and that the work will be done in accordance with San Joaquin County Ordinancesr 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, 1 shall not employ any person in such manner as to,become subject to Workman's Compensation laws of California." 1Signed ----------------- - - --- i.l _ Owner BY ----- ----------------------- --- -- --------------- -- Title ----- :-: '4 (If other than owner) rt 4"DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- --- ---------------- DATE --- Y---'--------------- BUILDING PERMIT ISSUED ------ --- ----DATE ---------------------------------- ------------------- - ADDITIONAL COMMENTS ----- - -- ' - ` --------------------------- = = .- s, n �� -------- ------------------------------ - - - Final Inspection b - ' ------------------ --- ------------------Date p Y ---------- - .;.,._..-� SAN JO QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M