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FOR OFFICE USE: APPLICATION-FOR SANITATION PERMIT Permit No- - --- _-------- - (Complete in Triplicate) - ------ I-- -------------------------------------- Date issued l�-`. This Permit Expires 1 Year From Date Issued 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: CENSUS TRACT ----- --------•----------- JOB ADDRESS/LOCATION .---+ (�!'� / � a ---- ----- Owner's Name I � - �-�--T------------------------ -----. ------------ ----------- ---Rhone .------------------ s�. ,�/ ------ ,� /r ,; Address -- / ;/ � /•"�° � Cityaf !'� Contractor's Name .--_ fl-f___( _.___--__-- ( ---�'� * ----------------------License Phone . Installation will serve: Residence ❑ Apartment House.❑ CommercialTrailer Court Mote! ❑Other ____._ -- - i 1 Number of living units:_'"_--- Number of bedrooms - ____Garbage Grinder - Lot Size _-_ ---1�--- - -Water Supply: Public System and name --------------------- --------------------------------�--- Private Character of soil to a depth of 3 feet: Sand'ESilt❑ Clay ❑ Peat❑ Sandy Loam -❑ C[ay Lo ❑ I Hardpan ❑ Adobe'9AFill Materia! -- ------ If yes, type -------------- --i-------- w. iI {Plot,plan, showing size of lot, location of system in relation 'r wells, buildings, etc. must be placed n reverse side.) 1 p seepage pit permitted ifspublic sewer is available within 200 feet,) m NEW INSTALLATION: (No septic tank or i PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] - Size-- --} -------------- "-------- Liquid Depth ---------------------.-- Ca acit ' - T e -------------------- Material----- -�� ------ No. Compartments - ---------------=---- Distance to nearest: Well -------------------------- ------ -Fovnda#ion ---------- - --- Prop..1Line ---------------------- LEACHING --------- _--------LEACHING LINE [ ] No. of Lines ------------- Length of each line---------------------------------- Total Length --------------------,------- 'D' Box -'----_- -- Type Filter Material --------------------Depth:FilteMaterial -___ -- - }----•------------• i 1 Distance to nearest: Well ----- ------------------ Foundation .-__ __---fl, - Property Lane. ---__-- --------=-------- - 1 1 J i - Diameter __------------- Number r, I Rock Filled,�'Yes ❑ No to 1 SEEPAGE PIT [ ] Depth ---i------I-- - -----------'---- -- ----- ' t ------Rodk Size J-I----------------------- U I � Water Table Depth , -------- -----------' ! i Foundation) - - Pra Line -------------------•-- Distance to nearest: Well -------------------•----------------- . - ------ p' f 'A iEPAIR/ADDITION(Prev. Sanitation Permit# -------- --------------- - ---- Date ----____-_.---- ------ ) I - -------------- Septic Tank (Specify Requirements) --------------- Disposal Field (Specify Requirements) ____�[e ----fid / F f----4---- -------------- --------------. - (Draw existing and required addition on reverse sid'6), 1 hereby certify that t have pry-epared this application and that the work }ill-be-�don�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 "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 ' - --------------------------- --- - --------------- Title --- ! ( er than owner / 6 FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____ DATE ___ a- { ! BUILDING PERMIT ISSUED ------------------ ---------------------------------------------------DATE ------------------------------------------- BUILDING COMMENTS ------------------------------------------------------ --------------,,:-----------------------------------------------------------=--------------------------- ----------------------- -------------------------------------------------------------------------- t_�. ►gl =:: = -._ ------- --------------------------- ------------------'----------- ------------- --- , ---------- --------------- -- -- _ -- ------- --------------------------------- Dato Final Inspection by: SAN JOAQUINtJLOCAC HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M