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FOR OFFICE USE- APPLICATION----- FOR SANITATION 'PERMIT {Complete in Triplicate) Permit No. _ --- ---------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the 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 ADDRESSAOCATION -- 1_- -- a--- -- - - 1 ---- .Y-- ------------------------- .CENSUS TRACT --------------_------_- Owne'r's"Namef� �✓ Phone ---------------------- -------------------------- --------------------- / --- - Address �� ----_,�----- ---- ----------------------------------------------!"CitY - -.... -F,�--- --- - / Contractor's Name __- _ -•-- -- --� - -- --:--------.Lice'n�s,�e,#/��'11$�Z- Phone Installation will serve: IREFsiclence']Apartment House❑ Com ericial ®Trailer Court ❑ :_ Motel Oth r - --------------- ---------- f Number of living unit?/// ... Number of bedrooms __�_-�_Garbag Grinder ___ Lot Size' _,? _ /^ �-- _ -- -------------------- Water Supply: Pub is System and name,- _- i / --_/ ,�"/ -.tf��f __________ _ -- Private ❑ �€ - . . ,, " Character of soil o a depth of 3 feet:,i Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay"Loam ❑ Hardpan ❑ Adobe ill Material ------------ If yes, type _____________ _____________ {PPot plan, show ng 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 [ ] SEPTIC;TANK![ I Size------------------------------------------------__-___ Liquid Depth --------------------------- i � Capacity -- --------------- Type -------------------- Material---------------------- No. Compartments -----------_---:--- Distance to nearest: Well ___________________-_-_-_-___--___Foundation __.. ----------------- Prop. Line ------------ _------6 LEACHING LINE [ ] No. of Lines ------------_----------- Length of each line--------------------- Total Length ----__`:.-_ --------------- _ * 'D' Box ------------ Type Filter Material -------------------Depth Filter Material --------- ----------.-- - '----------'`-O Distance to nearest: Well ------------------------ Foundation ---- ------------------- Property line ---------._"---._L_---- SEEPAGE PI* [ ] De th 1 _ Diameter ________________ Number -----------_-_- ______ Rock Filled Yes ❑ N� 103 Water Table Depth _ Rock Size ______________________________ Distance to nearest: Well -----------------------------------_---Foundation -------------------- Prop. Line ---------------------- ti { REPAIRJADDITiON(Prev. Sanitation Permit`# ________________ -` Date •-----) Septic Tank II-S cif y Requirements) __________________ ----------- - - ' ------- -_-• Disposal Fi d (Specify Requirements) ----- ----------_/-"- --- ----------------------- A ------ ---------------------J!---------------------------=-------------------------------- --- ------------------------------ --------—------------------------ 1 (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 accordanhe with San Joaquin County Ordinances, Stdote. Laws,-and;,Rules. and Regulations of the San Joaquin Local Health District. Home owner or liven- .d sed agents signature certifies the following: "I certify that in thb performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject4o Workman's Compensation laws of California." Signed ---- ------ - - ------------------------- ---- ---------- , . { ----------------- Owner Y ------------ ----- -- -- 1' Nofher owner] 4;a;,2 PARTMENT i' USE ONLY),e APPLICATION ACCEPT EDr BY - . - -------- - -----------------------------------------------------. DATE -•----- _. .- BUILDING PERMIT ISSUED ----- --- -- ------- - ---------------------------------- ------;--------------DATE ------------------------------------------- ADDITION COMMENTS ------ _ ---- - ---------- j� - :, - -- ----=------ / �' -- k�' s✓ rub' Q f' -- ------ - - - - fr�j-� a ff�" w - -�' -�P-'r -"'�""�"t- -/'rte -� -�f C: --� +E --- Finallnspectionby: Date �Z _ d ` NJOwulty LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5 F