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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .......... (Complete in Triplicate) Permit ........ ....................... .... . ..... ........... ......... ... This Permit Expires I Your From Data 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 mode in compliance with Courity Ordinance No. 549 and existing Rules anti Regulationss JOB ADDRESS/LOCATLG44� ...... . -:-,'49NSUS TRACT ......................... ...... ........ t— ............ one ........ ............ . ........ . . Owner's Name Address ....... city., .._....,.............................». Contractor's Name ........ .........e Phone .............................. Installation will serve- Residence []!rApartment House Commercial oTroller Court 0 Motel C] Other. Number of living units ..... Number of bedroornsLot Size ..... Water Supply: Public System and name ........... ........ .. . . . ........ . ... . .... Private [A— Character of soil to a depth of 3 feet: Sand Silt 0 < Cloy* r, Peat Sondy Loom C3 Cloy Loom Hardpan Adobe Fill Material ....... . If yes, type ............................ (Plot pion, showing size of lot, location of system In feJbti . 6n to wells, buildings, etc. must be plate• d on reverse side.) NEW INSTALLATION-,JNo septic- tank or seepage. pit permltt6cl If public sewer is cwilable within 200 feet,) PACKAGE TREATMENT 1 ] SEPTIC TANK Sizc...................•._..._.....,................. . Liquid Depth ............ _ ....... ::fv Capacity .... ...... Type .......... Material...................— No. Compartments .................... Distance to nearest. Well ............... Prop, Line ................... . LEACHING LINE jNo. of Lines .... .................... * length of each line .......... Totol'Length .... .............. . ....... V Box _ T,�� Filter Material ....... .... ... _-Depth Filter Material ...... ... _ ....... Distance.to nearest.. Well ........................ . Foundation ...... _.— ...... .... Property Line ....... ............ SEEPAGE PIT Depth _ ................. . Number ............................ Rock Filled Yes No Water Table Depth ............................. . ............---,Rock Size ......................... CIO Distance to nearest: Well ... .. . ..... I . . . . . .. . ........... Foundation ...... . ............ . Prop. Line ..................... J 1c: gyp REPAIR/ADDITION (Prey. Sanitation Permit # ........ ......... . ....... Date ......... ..... Septic Tank (Specify Requirements) ....... ............................... Disposal Field (Specify Requirements) ........... ............. .............. jorow existing and requirediraddition on reverse side) .... . ............. I hereby certify that I have prepared this application and that the work I will be done with Son J"quln County Ordinarites, State Laws, and Rules and Regulations of the Son Joaquin L"ol H#alth 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 parson in such manner as to became subject to Workman's Compensation laws of California." Signed......... ....... I ....... __ ................ Owner By...... > .............. ...... ........ . ..... ... ........ ...... ....... Of other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y......... 1.___ ...................... ......... ..... ......... .--. ...... DATE BUILDING PERMIT ISSUED ....... 4 . ........ .; - -------- ...... ......................... DATE .................. .............. ADDITIONAL COMMEN TS, ........... ................. .............. ** ........ ........... & ........ ...... ..... ......... ........................................... I ......... ...... ....., .......... ...... ........ ........'_.......................,...'........I................. ............... .......... ......... ....... . ..... ......... ...... .......... ....... . .... .......... **LIIXI�9 ............. . . .......... I ................... . .................. ............. I......., ............ A./. . ...... Final Inspection ............. Z ................. 'f.V ....... ... . ........... Date .......... SAN JOAQUIN AOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev. sm 7172 3A