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FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT / �/ ---------- ` Permit No. .(��-�--�� (Complete in Triplicate) . -------------- - Date issued " -_�-y_� - This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 1. described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: - JOB ADDRESS/LOCATION ._-._ -�-`----- TRACT --------------.----------- JOB - •- ----- - =` -------Phone -- - 3� -----�-------- y Owner's Name ,h ---------- '`f- i off-------------------------- r, r� _ city - N --------��—�1 ------- Address -------------------------- - f------ u5-,1-�ti-------- Z J Y ' le--- f 'An------=- -----License #1 ------ Phone L a O]=5 Contractor's Name -------� ------- ` Installation will serve: Residence Apartment House'❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- Number ------------- ----------------------------Number of living units:---------- Number of bedrooms -,-,,3-----Garbage Grinder --- Lot Size -------------------------------------------- Water -_--------_ ----- . Private :I Water Supply: Public System and name ------------------ ------------------------------------------ -- " --------------------------- vl Character of soil to a depth of 3 feet: Sand' Silt El Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam :❑ Hardpan ❑ Adobe'❑ Fill Material ------------ if yes, type ---------------------------- [Plot plan, showing si a of lot, location of system in relation to wells, buildings, .etc. must 6e placed on reverse side.] septic tank or seepage pit permitted if public sewer is available within 200 feet,) ' NEW INSTALLATION: (No p P `f I,'PACKAGE TREATMENT [ ] SEPTIC TANK' Size-- xW,----x-U/---- -- ---- Liquid Depth - �'- ---- - Capacity---- TYpe�.r4Materials p < No. Compartments'� --------Foundation 1 Prop. Line --.----Distance to nearest: Well -- Len th of each Eine-- --7- ---------- Total Length _"/"sp--._-•------LEACHING LINE [ ] No- of Lines ---_ g "I- - -- --- - - De th Filter Material _-/ - CI D' Box -._�_- Type Filter Material P -•-�-----" s l - Foundation - -- ---- Pro Line. I Distance to nearest: Well --,_S�_____________ �� ►� SEEPAGE PIT Depth --- Number -------------- ------------- Rock filled Yes ❑ No .i❑ [ ] - - ------ - - --- Diameter ---------- � � I ` Water Table Depth .—� ` _hock Size -------------------------------- ; ----------------------- ----Foundation --------------•---- Prop. Line ------------- -------- ,4 N Distance to nearest: Well -.__"--------_-_--_-_---."__--.- _- ! I Date -----------! ---------------] ` REPAIR/ADDITION(Prev. Sanitation Permit# --- --------------------- f Septic Tank (Specify Requirements) -------- ------------------•------------- ----------------, -- ------ .. Disposal Field (Specify Requirements) ---------------------"--.__-_-____- ------ ----------------------------------------------------- v ,E ,. � ------------------ t ` f' 4 f -------- - --- ---------- ----------------- - (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 Sar+ 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 beco p su ' ct to Work an's/C Fe--n--satlzn laws of California." Signed _ �C - 1 ll -S------- Owner By Title ---- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -l- -- DATE -- U �`�---------------- I BUILDING PERMIT ISSUED ------ ---I-------- - -- -------------- ADDITIONAL COMMENTS --- ----- { - -------- -------------- ----------------"--------------------------------------------------------- > --- --- ----- ----------- -------------------------------------- ----------- f --------------------------------- ---- ---------------------------- - ------------- ----------- - ---- ---.gate ---- -- Final Inspection by: . -5---- -- -- ---- T1 �3 SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M