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FOR OFFICE USE: � 'APPLICATION FOR-SANITATION PERMIT -y- _( --------`4,!Au X —----- -Permit. NolPg r� - ----=-=---------- (Complete in Triplicate) J - Date lssueds- �_J. } This Permit Expires 1 Year From bate 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 CENSUS TRACE --•- ADDRES51LOCATI N -- ---------- ----------- -``-'�- ----` `� (�Q I �—�d'S'` Owner's Name � � —f !1 F � �'1 ----Phone t Addressr9------- ------------------ =-j City ' ` ) Contractor's Name~-----__-- . . l' - �'- -t1--- - - ------------- F-------License # 1 _ Phone6 `ell. ��. Installation will serve: Residence ❑ Apartment House❑ Commercial []Trailer Court ;❑ Motel ❑Other Number of living units:------------ Number of bedrooms ------------Garbage Grindgr ---------_-- Lot Size _--__ X__l-4. ----....___. I . — Water Supply: Public System and name ----- jW___:pt----- -- -- ---------------------------- -------------------------------Private ❑ Character of soil to a depth.of,3 feet:,,,,_.Sand[] Silt❑ , Gay ❑ Peat❑ Sandy Loam - ] Clay Loam ❑ � I Hardpan ❑ AdobeX Fill Material ------------ If yes,type ---------------------------- Z (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) p seepage pit permitted if public sewer is available within 200 feet,) Gj NEW INSTALLATION: �{No se tic tank or PACKAGE TREATMENT SEPTIC TANK Size_ /� - _ ---.---- Liquid Depth ___-5 ----------------- �► � � t ------------ Distance -- ------ Capacity --�8_Cq_,_- Typeelte-6-4-tMaterial��G__.____ No. Compartments I Distance Ito nearest: Well _7 ------------------Foundation ------ Prop. Line ------- LEACHING LINE allo. of Lines ------�__------ Length of each line/40---------------- Total Length _--G2 _ Len -ja--------- w D' Box J/ Type Filter Material � -�_O.� f�,Depth Filter Material ------ ---- -----------------�_-_._-_--- ,�. . �`i Distance to nearest:;Well ------- Foundation ,C "-- ------ Property Line ----- -------------- SEEPAGE PIT Depth --- -- _ r Diameter -�- - ------- Number - Rock Filled Yes No XV 1� 111 01 Water Table Depth ------- --------------------------Rock Size : --------------- Distance to nearest: Well ` �---------------- --,� ---- Prop. Line ------?-_............ .r I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------- ------- p� Septic Tank (Specify Requirements ) -_________________. ` 1 DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- x ) (Draw existing and required addition on reverse side) y 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 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, I shall not employ any person in such manner as to becp�Fte subject #o rk 's ComBensFi laws of California." Signed *-- ,;7 � ' - ----- ------ - ------ `-------------- Owner BY --------------------------------------- - --------------- Title -- ------------:=----- ------------ ---------------------------------- (If other than o ner) I FOR DEPARTMENT USE ON APPLICATION ACCEPTED BY --`---�-�---=--- ----- - ------------- -- ------------ -- DATE - _� i- -G BUILDING PERMIT ISSUED --------- -------------- ----- --------------------------------------- ------- ----------------------- --DATE ------------------------------------------ ADDITIONALCOMMENTS --------- - ------------------- ----------------------------------- ------------------------------------------------- ----------- ----------- ---------- - -------- ----- -- - -- - - ---------- - 4` ---- Final Inspection by- ---------------- Li1. �2v -----.Date -. I b SAN JOAQUIN LOCAL HEALTH. DISTRICT , } E. H. 9 1-'68 Rev. 5M