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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: F�3,a ------------------------------ \ This Permit Expires 1 Year From Date Issued "•a° .Q}e Issued ---------------------- 'Irk is hereby made to the San Joaquin Local Health District for a per to construct and install the w rk herein described. This application is madein compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._, ..__- .______. ,y CENSUS TRACT --------------------------- Owner'sI Name -----------------/_�-�a'_---------6? -- --�F-- - - ---------- ------------------Phone �UT ! f:n _72��-- Address ----- -----�---��"�=�---�fZje-�-��=---------------- City --�--�� ---- ----------- - --------_---------------------------f Contractor's Name ---- -Y}.�c__,.. i _f. _j �` License # _ f Ll f = Phone ------- Installation --'Installation will serve: Residence [2-Apartment House,❑ Commercial ❑Trailer Court i❑ ' Motel ❑Other -------------------------------------------- Mp Number of living units:___-__ _--_ Number of bedrooms ----�Z-----Garbage Grinder ------------ Lot Size ------------------------------_------_...... Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private ❑ 71 Character of soil to a depth of 3 feet Sand'[' Silt❑ Clay`[] Peat❑ Sandy Loam •❑ Clay Loam ,;Hardpan ❑ Adobe-❑ Fill Material ------------ If yes,type ____________________________ t .! (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,) 0 PACKAGE TREATMENT [ ] SEPT}TANK Liquid Depth _______________ __ L` [ l Size - . �.,?_'.--�'`r-�'��'�-------------- Capacity -,- -D_�'-.,-- Type u'_r � JMafienal-_ ;i �,�C_�No. Compartments -- --------•-•--•.- Distance to nearest: Well -------&70-:_______________Foundation ---------- ________ Prop. Line �_j_______-___- LEACHING LINE [ ] No, of Lines _.___:,�"�-_'_________ Length of each line_______ ___________ Total Length :__� _�............... 'D' Box ----= ----- Type Filter Material . rf?` -__Depth;Filter--Material- --:.:-.. -_.__.- ------------------------ Distance -- --Distance to nearest: Well _______________________ Foundation ------------------------ Property Line -_______---_____........ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------_________ Rock Filled Yes ❑ No C] WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _________--___--_-__._-_______-___) SepticTank (Specify Requirementsl ---------------------------------- ----------------------------------------------------------------,--------------------------•-- 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 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 Wa mans Compensation laws of California. Signed' ---------------------------_ Owner _ /� � 1 BY --------�-�•�--�----- �-�-�--- - -- ---------------•--------=- - •- -------- Title -------------- ---- - - ------------------------- (If other than owner) y I FOR DEPARTMENT USE ONLY G . APPLICATION ACCEPTED BY --------- ------------ .< . DATE -`� r 1 BUILDING PERMIT ISSUED --------------1:------------------------ ---- ----------- -------------------- --DATE ------------------------------------------- ADDITIONALCOMMENTS ----------------------------------------- -------- ---------------------------------------------------------------------------------------•------------------ i --------------------------- ------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------- A ------------------ Final . ----------------=------- --------------------- Ins ection bY: --------------------------- ---------------------------------------------------------- --- - 3_______Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C Tom- 1