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{ FOR OFFICE USE: = APPLICATION FOR SANITATION PERMIT --------------- --------------------------------- --- - (Complete in Triplicate) Permit No. • S---�`'f��/. I -- -------------------------------------- --------------- 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. .49 and existing Rules and Regulations: e JOB ADDRESS/LOCAJOAN -- •_------- f-------- ---------CENSUS TRACT --- 641----------•---- Owner's Namef_'11 Phone ------------------------------------ Address !� Cit .�� ------------------------------------ ,� Y Contractor's Name .- . _ ---- ----. 1� � e ''/ License # - �i--- Phone I Installation will serve: Residence A Apartment House❑ Commercial ❑Trailer Court i❑ ( Motel ❑Other - ------------------------------- Number of living units:-.-,/----- Number of bedrooms _----__Garbage Grinder/44__- tot Size i t"- .�� ----------- Water Supply: Public System and.name- ------------------- `----- - ------------------------------------ •------- ------ Private, Character of`soil to a depth of 3 feet:Sand'❑ Silt❑ yf Clay ,❑ Peat❑ Sandy Loam ❑ Clay Loam,[] Hardpan ) Adobe ❑ Fill Material ---_-------- If yes, type ----------- ---------------- II (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,) ` t PACKAGE TREATMENT { ] SEPTIC TANK' Size ------------------ Liquid Depth v-___.----_-------_ Capacity Typ _ Material l�7� `__ No. Compartments ;111 ._- ..._ - -- ---- - -- 3r. -- f----------------fouDistance to nearest: We ----- ndation -------- Prop Line .... LEACHING LINE M No. of Lines --_ - Length of ac line- ------------ Total Len D' Box )�� "- Type Filter �a�l- ;.Depth FII`r Material. ------------------- —---------- O+ 7 ``f . Distan a to nearest:.Well - -- --- ------------- Foundations` ------_ - ��'-'- -- -- Property Line -,$TV--------•_-_-- I� SEEPAGEjPIT •.� Depth K-&7,---------- Diameter - ---- Number ---t54�------------------ Rock Filled Yes; No I❑ Water Table Depth -------`--------------------Rock Size` _.S�_�_`-------- f - f;4�s -- 1 Distance t"o'. iearest: Well __ ------------------------Foundatio•n ---- Prop. Line %O:V. ---------- REPAIR/ADDITION(Prev. Sanitation Permit_# ---- --- _•, ) - ------ Date -- -----• -- ----- ---------------- Septic Tank (Specify Requirements) ---i------------------------ ---------- - - ------- ----------------' ------------------------••-------- ------------------- Disposal Field (Specify Requirements} ------------------------------------------ ` ---- - --g- -------------------------------------- --------------- ---------------------------'------------------------ ' ----------------------------- ------------------ - -- ----------------------------------------------- ---- - - ------------------------------------------------ ---------------------- <r (Draw existing and required addition 1pa, reverse side) I hereby certify that I have prepared_#his application and that the worlF`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 following.- "I ollowing:"I certify that in the performance of 4he work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." r i Signed --- --- -- ------- --------------- ---- --------------------------------------------- Owner! BY --------ltd . --------------------------------- Ti#le ---- ,e ��- ----------------------------------- o her than owner FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY -------------- --------------- DATE -+-7------------------------ x BUILDING' PERMIT ISSUED ---------- ADDITIONAL COMMENTS - DATE --. --=------------------------------ --------------------------------------=--------------------------- ----------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- - Final Inspection by: --------------------------------- - -- - -----------.Date a � � y -------------- f SAN JOAQUIN LOCAL HEALTH DISTRICT E, H. 9 �. r- 1-'68 Rev. SM �,:rte� ..�� '.�',.,;• �; � �'��'�• i-� � F, .� ..