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EOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - Permit No. -------------------- ------------------------------------ ► (Complete in Triplicate) ------ ------- ------ Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is madein compliance with County Ordinance No. 549 and existing Rules and Regulations: 4 JOB ADDRESS/LO TION - -----�------ -nCa/'---- f CENSUS TRACT , f---�- ----------- -------Phot -r'�- ---—/ Owner's Name � --�--h i------ � .r ------��1,_ .--...----- --- - Address ---- -PI- G2 ------------------------------------ Cityt 6� � ~' Contractor's Name - 1-� • �al �P----- -------.License ill SF_--- Phone -r ,r Installation will serve: Residence KApartment House-F-1 Commercial :❑Trailer Court 'E] fMotel ❑Other --------------------------- ---------------- Number of living units:------------ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ------ ------------------- -----------• --- Water Supply: Public System and name ----------------------- ------------------------------------------------------Private ❑ t ❑ y Peat Sand Loam Clay Loam ❑ Character of soil to a depth of 3 feet: Sand' Silt Clay ❑ ❑ Y ❑ Hardpan F-1Adobe'❑ 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 publi sewer is avail le within 200 feet,) I ---- Liquid Dept -------------------------- PACKAGE TREATMENT 11 SEPTIC TANK'[ ] Size----------- ----------------------- q Capacity --- Type -------------------- erial------------- ------- No. Compartments ------ -------- U1 Distance to nearest. Well ------------- -------------Foun tion ---------------------- Prop. Line ----------------...... Cy LEACHING LINE [ ] I Length each line--- - _----._ ---- Total Length ------------- No. of Lines -------- ---------- ------- - - ,rn � 'D' Box .._I-------- Type Filter Mater- ------------------ - epth Filter Material Distance to nearest: Well -------- ----------- -- Fou ation ---------- ------ Property Line ------------------•-•-•- 1 -----_--- Diamet --- umber --------------------------- Rock Filled Yes ❑ No SEEPAGE PIT [ ] Depth ----------- - "fl WaterTable Depth --------- --------------------- ---------------Rock Size -------------------------------- D'++stance to nearest: We ...............Foundation Prop. Line ---------------------- I Date - ---------- �1 �d REPAIR/ADDITION(Prev. Sanitation Permit ---------------------------- - �� Septic Tank (Specify Requirements) ---- -- ------------------------------------------------------=-------------------•------------------------ --- -------------- -_, ---------/ ------------------------------------------------- Dispo al Field (Specify Requirements) -------------------- ----------�---- ----- ----------------------------------------------------------------------------------- ------- I I (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, acrd 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 become subject oWor an's Compensation laws of California." c Owner Signed --------- ------- Title ---- ---------------- ------------------------ --------- --------------- BY ------- ---------------- If other than owner) FOR DE.PARTMENT USE ONLY -------------- APPLlCAT10N ACCEPTED BY3F------- ----------------------- --------------- DATE --- �- ---------DATE -_. BUILDINGPERMIT ISSUED --------'- ---------- ------------------------------------------------------ ---�- -- + ADDITIONAL COMMENTS -----------�----------------------------------------- -------------------------------------------------------------------------------------- ----------------------------- ------------------------------ -----------------------------------•-------------- - ------------------------------------------------- ----- -----------------------------•- - ! ------- -----------�------ -- ---------�-- F Date -- -- ------- - Final Inspection by l SAN JOAQUIN LOCAL HEALTH DISTRICT } E. H. 9 1-'68 Rev. 5M