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FUR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---------- ---------------- ---------------- (Complete in Triplicate) - ----------------------------------- Date issued This Permit Expires 1 Year From Date Issued Application isherebymade to the San.Joaquin Local Health District for a permit to construct and install the work herein with County Ordinance No. 549 and existing Rules and Regulations. described. This application is made in compliance s / gyp . CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION _ "� ------- 114 ------- -----------Phone -- - 1 Owner's Name._,,_ / - i --- -------- Address Q-------�Q------ -----. City -,c51��K�_ ------------------------------- License #� 1 Phone 7 Contractor's Name _.��1.['-�----z�.��-�'------ =--� Installation will serve: Residence Apartment Nouse f❑ Commercial :[']Trailer Court i❑ Motel ❑ Other -------------------------------------------- Number ------------------------Number of living units:_-. ------- Number of bedrooms ----/------Garbage Grinder"_,/Y0-__ Lot Size �r�!7� _ -----------•-•- k ._-_-Private Water Supply: Public System and name ----------------------------- --------------------------- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:� ' Hardpan ❑ AdobeX Fill Material ------------ If yes, type ---------------------------- 010t plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: (No septic Gtank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK![ I Size------------------------------------ ----------- Liquid Depth -_-------------------.-• -- Capacity Type -------------------- Material---------------------- No. Compartments ---------------------- . �" Foundation ----------------- Prop. Line ------- ----------- , Distance to nearest: Well --_-- p ------ Total Len ---------- LEACHING LINE [ ] No. of Lines------------------------_ Length of each line----------------- Length •--------------•. '-`F --De Depth Filter Material -------------- 'D' Box--- --------- Type Filter Material - P Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---------------.__-__--_ SEEPAGE PIT De th Diameter Nmber ---------------------------- Rock Filled Yes ❑ No 0 [ ] P ----------- IWater Table Depth ----------------------------------=-----•- -----Rock Size -------------------------------- Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line ---------------------• F REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------- Date ----------------------------------) Septic Tank (Specify Requiremets) -------------------------------------------------------------- I , yr Disposal Field (Specify Requirements) ----__--- � •---✓ . /T---= � -�`�"'1-- �� " ( rte` ---------------------------------- ---------------------- ---------------- z - ---- -------------------------------------------------------------------------------------------------"----- ------------------------------------------------------ ------- (Draw existing and required.addition on reverse side) 1 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 fallowing: ' "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to orkma 's Compensation laws of California." Signed = "=�-----------r-----Owner �— -- ---------- �- .,., ' Title -- ------------ --- BY -- ------------ ----------- (I er th owner) FOR DEPARTMENT USE ONLY �+ APPLICATION ACCEPTED BY 4 DATE _-`C f-14-f 1-�'---------------- ' BUILDING PERMIT ISSUED ---------- ----- ------------- DAT ADDITIONAL COMMENTS - -:----------------- ----- - -------------- ---------------------------------- --------------------------------------------------------------------------- ---------- - --- -- --------------------------- \--Z-----Final Inspection by: Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M "'___