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;. 'KJ <br />Disposal Field (Specify Requirements) <br />Septic Tank (Specify Requireme-nts) <br />DEPARTMENT USE ONLY <br />7-L , DATE <br />DATE , <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />FOR OFFICE USE: <br />...... • - <br />Permit No. .. <br />Date Issued • <br />Application is hereby made to the San Joaquin Local Health District for a <br />described. This application is made in compliance with County Ordinance permit to construct and install the work herein No. 549 and existing Rules and Regulations: <br />4 <br />JOB ADDRESS/LOCATION 00'• ... <br />•••• • <br />(?..; City <br />NNLice.n <br />Number of living units: ./.. Number of bedrooms ...y. .... Gart;age Grinder .... .... Lot Size <br />Water Supply: Public System and name • *-, 1 , _--------------------------Private <br />Character of soil to a depth of 3 feet: Sand 0 Silt 0 .Clay 0 Peat E. Sandy Loom Clay Loam g <br />'!I Hardpan 0 Adobe '0 Fill 'Material If yes,-type .1- <br /> <br />Residen <br />Motel D Other ....... _.... _ _. .*: .-•.'i ..... _.. ; <br />Apartment House 0 CommerCial <br />r . . • 't•T 4 , i • <br /> <br />-.0*--K,--i r <br />., i • t <br />'4, t <br />".?•• <br />€1., .•••••••,, <br />; <br />t # es i i <br />size of lot, location of system in relation to'wells, buildings,. etc. "m6it i be placed on reverse side.) <br />, <br />(No septic tank or seepage pit permitted if public seefisjovailaeIe within 200 feet) r <br />( ]', SEPTIC TANK f ] Size -4 . ! Liquid Depth <br />r <br />Capacity Type ... .-1.070-jirial. 4'2 ,I No. Compartments <br />t <br />Distance to nearest: Well • Foundation ..... .... Priap, Line .. , .. <br />.r <br />ne <br />.1 <br />led' Yes 0 lit) <br />1 Water Table Depth <br />1 I I I Distance to nearest: Well <br />REPAIR/ADDITION (Prey. Sanitation Permit # I <br />- <br />Owner's Name ... <br />Address . 1 . <br />Contractor's Name <br />Installation will serve: <br />.CENSUS TRACT <br />Phone ... <br />(Plot plan, showing <br />NEW INSTALLATION: <br />ITC-kA-G-E TREATMENT <br />i's• I <br />LEACHING LINE <br />SEEPAGE PIT, <br />'D' ,Type .Mciterial .;; .... Material <br />1/44, <br />--Dittonee`toThearest: Well Foundatian Prope <br />d <br />( Depth -."-- - :.,/. Diameter . Number i ...... .............!...,.. Rock Fl <br /> Rock Size ' , <br />Foundatian Prop Line <br /> <br />- ) e‘. <br /> ' Dote 1 ) <br /> <br />\r' • <br />No. of Lines .1 Length of each line. I?, I -Total -Length- <br />I ' ' 1 4 i . <br /> <br /> . ..... . <br />(Drow,existind bad required addition on reverse side} r t i , <br />1,hereby certify that I have prepared this' application and that the work will be done in accordance with San Joaquin <br />County Ordinances, Skate taws,"andlules -and'Regulations of the Son Joaquin Local Health District Home owner or licen- <br />sed agents signature certifies.the following: <br />"I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner <br />as to become sublect to Workman's Compensation laws otgalifornia."-- i <br />r _ - <br />Signed . <br />... Owner <br />By. <br />01.,:412,62 <br /> ........ . , ...,.. Title <br />6 owner) <br />' <br />APPLICATION ACCEPTED BY ...... <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br /> <br />• <br /> <br />....... y ... - • ..... <br /> <br />_Date <br /> <br />Final Inspection <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> <br />E. H. 9 1-'68 Rev. 5M