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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 Issuced ".�� ]-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install tli e work herein described.,This application is jnade.in compliance with C unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -__-------__ / _"CENSUS TRACT _""S_ '""_-."..._""" - -----� - ---� K--� - Owner's Name -- -- - ------ ---------- ------------------------Phone ---- Address _. �_�f_ �__ --------- • -- --�--- -- ------ - ----------- city -:---&F--�-1-------- V. Contractor's Name ------ , -- ------ -------- -- -�'_----License #�,9 --- Phone Installation will serve: Residence 0Apartment House�❑ Commercial ❑Trailer Court ;❑ Motel ❑Other Number of living units:------I_--- Number of bedrooms _"" _---Garbage Grinder ------------ Lot Size ----9-4-&_ _ - ---"----__ Water Supply: Public System and name ------------------------------------ _------Private Character of soil to q depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ Hardpan Adobe.0 Fill Material -------- If yes,type -------- ------------------- 41 W (Plot plan, showing 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 Illublic sewer is available within 200 feet,) ( ' I PACKAGE TREATMENT ( I SEPTICTANSize K [ " fi --_ _�_ f J < � /------ Liquid Depth ------ ---- -•--------- Capacity P �------ .�A-" _ Type Material_-__ __"__""" No. Compartments ' P ------ �+--- Distance to nea est: Well "- _�-------------Foundation """ p----------- Prop. Line ---.-- LEACHING LIN1= [ No, of Lines _-""" �____"__-_._" Length of each line--------Jo_Q__e----- Total Length --_--- -$ 'D' Box -'/------- Type Filter Material --------5-fZ"-_Depth Filter Materia! ---------L!F-I_, Distance to nearest: Well ------_�0_!------ Foundation --------/99 --------•-- ""______ Property Line ------��__ � i - SEEPAGE PIT [ Depth "___�--s __-_--- Diameter ------ Number --------__--". -__ ----- Rock Filled Yes No ' /r d/ Water Table Depth ------------------P --------------------Rock Size --- -- '-r--�'�-��--------- f Distance to nearest: Well ------------- es . .----------Foundation -------- --------- - Prop. Eine _......--------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ___-_--_--_-_--_--_-_ -Septic Tank (Specify Requirements) ------------------------- ---------------------------------------------- ; Disposal Field (Specify Requirements) -----------" ----------------------------------------------- ------------- ----------------------------------- - (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 San Joaquin Local Health District. Home owner or li w 11 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 BY ---------------------------------------------- ,9'__ I/ (If other than owner) ---------------Titlei -rst/---------------------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �L ----- ------------- -------------- BATE BUILDING PERMIT ISSUED ------------------------ - DATE ------- - _-•- ADDITIONAL COMMENTS --------------------- - --------------------------------------------------------------------------------------------------------------------------------------- 4 --------------- - ---- -------------- "- - ' --------------------------------------- Final Inspection by: ------" -------.Date " " SAN JOAQUIN LOCAL HEALTH DISTRICT r rr E. H. 9 1-'68 Rev, 5M