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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT k Permit No. ----- --------------------------------------------------- (Comple=te in Triplicate) ----------------------------------- Z 3 1 71� Date Issued 3................. This Permit Expires Y 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'made in compliance with County .Ordinance No. 549 and existing Rules and Regulations: _ 6�_ ---------------- ----------- ------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION ¢�-`4=-'�-�°- Owner's Name .., rl� _ _/.: � = �;- -------------------------------------- --- Phones. . - � Address s-_�-r_ - p- 44 1 4 r ._.+.,_. City --- y _ �� �j ......................... g' Contractor's Name �' - - ._.License #X - -- Phonecpz-_-T '- ]�.: ----------- ----------------------- --------- Installation will serve: Residence A_;(Partmenfi House❑ Commercial []Trailer Court ;❑ " Motel ❑ Other -----�`-]------------------------------------- Number of living units:_(...__-- Number of bedrooms•�.-----Garbage Grinder --- -------- Lot/Size ------------ -------------------------------- i ldlt��%/� �� Q. rL ' ✓ ----Private Y -------- --- �1 �_--------- - y /` .r Water Supply: Public System and name .. - Character of soil to a depth of 3 feet: Sand' 11 ❑ Clay ❑ Peat❑ Sand Loam ❑ Clay Loam 0 t ' Hardpan F-1 ❑ Fill Material ------------ If yes,type -------------------------- (Plot plan, showing size of lot, IoLation of systemF in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public se e is available within 200 feet,) // � Liquid Depth ------------- PACKAGE TREATMENTCapacSEPTIC TAN:KQ[A----- - rSize -- TYPA2-6 -�� . Material 6'- -CW, No. Compartmentsartme n�ts- ..-..s.. .........-. - --------.-- Prop. Line -- •----------- tato nearest: Well --------------------Foundation, - - --�------- LEACHING LINE [LNoof Lines -------`r--- Length of each line--�� - --. Total Length - f m 4 /,� iI 'D' Box ._ Type Filter Material DVVc/V..-_----Depth Filter`Material ?----------------------------------•-- . , I T 3 I L` Distance to nearest: Well pQ_---------- Foundation --T --------------- Property Line _.- ---------------- SEEPAGE PIT [ ] Depth -- '---i---' ---- Diameter ------------------Numiier .-----.--------- ------ Rock T=illed Yes ❑ No ❑ Wafer Table Depth----------- ----•- --------Rock Size -------------------------------- ----------ilFoundation # Prop. Line Distance to nearest: Well .--._..._..-._.. REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- --------------------- Date ----------------- ---------- } ' i Septic Tank (Specify Requirements) ------- ----------------------------------------------- - /10 Disposal Field (Specify Requirements) -----------_ --- -- 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 �i 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 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." {k F Signed { , � Owner I Title owll /- � `--------------- ----- - BY -- ------- - C� C ' [If other than owner) � FOR DEPARTMENT USE ONLY DATE -.... ---------------------------------- ------ x 7 -�� APPLICATION ACCEPTED BY -- _--- (� - - ----------------- PERMIT ISSUED --------- ------------ ---- DATE -------------------------------------------- BUILDING ADDITIONAL COMMENTS ---------------------------------- ------- -----------------------------v------- - ---------- ---------- - 3---------------- ----------------------------------------------- --------------------------------------------------------------------- ---------------------------------------- ------------------------- ------------------------------------- ---------------------------- ------- --- ------ ----------------- .Date ------- - ---- ---- - ------- Final Ins ectionb 4eL ------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -