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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -----------------1�-�a--` (Complete in Triplicate) Permit No. -161.J-- 31 ____ 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 ADDRESS/LOCATION -- ---,-- '� �. -(�----------- � 1 ----CENSUS TRACT -------------------------- Owner's Name 11 £V��/7------- ls� s . '��-----I------------- ---------------- --- Phone AddressCity / E/� > Contractor's Name --- License Phones✓'% ` installation will serve. Residence A Apartment House❑ Commercial ❑Trailer Court ',0 Motel ❑Other ------- -------------------- -- Number of living units.__ _---- Number of bedrooms _et-------Garbage Grinder lto'�7._ Lot Size _--__-------.--. Water Supply: Public System and name ------------------------------- ------------------------- -------------------------------------------------Private Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan F] Adobe 't—x'/ Fill Material ------------ If yes, type ----------_---------------- (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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size----------------------------------------------- Liquid Depth --------------------------- Capacity -------------------- Type -------------------- Material------ --------- No. Compartments ------................. Distance to nearest: Well ------------------------------------Foundation --- ------------------ Prop. Line ---------------------- LEACHING --.------ .----.LEACHING LINE [ ] No. of Lines --------------- ------ Length of each line---------------------------- Total Length ------.--.- 'D' Box - Type f=ilter Material --------------------Depth Filter Material --------------------.--------_-_-_---.-.--_- e Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -----------_.--__-.---. SEEPAGE PIT [ ) Depth -------------------- Diameter ---------------- Number ----------------------------- Rock Filled Yes ❑ No .0 Water Table Depth ------------------------------------------------Rock Size ----------- -------------------- Distance to nearest: Well ---------------------------- --..._Foundation -------------------- Prop. Line ----------------_---- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------- -------I Septic Tank (Specify Requirements) ---------------------------------------------------Z- -------------------------------------------- ---`-- ----- -- ------ ` ------------ :- --------------------------- Disposal Field (Specify Requirements) ---- a_------ ----- - f-,11-----�s�i-- ---- -- --- ------------ --------- -- -0-1--- 4 ------------------------------------------------------------------------------------------------------------"-------------------------------------------------------------------------------------------- {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*loaquin 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 become subject to Workman's Compensation laws of California." Signed --------------------------- ---------- Owner B -------------------- - - ----- Title (If othe an owner) ` FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . IC-4---A/0...... ---------------------------------------------- DATE 3- '--------- BUILDING PERMIT ISSUED ---- -- -_DAT -.-- --- ADDITIONAL COMMENTS --� 3_- --6 - -------------- - ---------------- -------------- --------------------- ------------- ------------------------------------------------- ----------------------- ------------------------------------------------ -- -- ---- ----------------------------------------------- - ---- Final Inspection b ,4--------------------------------------------------- Date _-- - L -- +--- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M