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FOR 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 permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549,cand existing Rules and Regulations: � f --�W-------- -- ------------ y r t CENSUS TRACT JOB ADDRESSAOCATION ._ __ - �'�"/ --- Owner's Name Ll_-- E ' '' Phone t/7&- --,/ 5 _ +1 AddressQ - --- ----------- — ----------------------------------- City --------'---!-------------------------- Contractor's Name OZ l----- ------.License #SMI; ------- Phone .74�-:_� •C-_ Installation will serve: Res iden ceyApartment House-E] Commercial :❑Trailer Court ',❑ Motel ❑Other --------- ---------------------------------- Number --------------------------------Number of living units.----/----- Number of bedrooms --_3---Garbage Grinder -------------Lot Size _.!-_ -2-c-n/J_ -------------- Water Supply: Public System and name ------------ --------------------------------------------------------------------------------------------------PrivateX Character of soil to a depth-of 3 feet:–'San�❑ 'Silt❑''Clay'"Q,/Peat❑ Sandy Loam`� Clay Loom.❑ .j, s Hardpan F-1Adobe❑ Fill Material ------------ If If yes,type/---------------------------- a (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,) _ of TREATMENT [ ] SEPTIC.7ANK� S' e---- --}C_ ------------------- -- -- Liquid .Depth - --- --------------- PACKAGE� � Capacity ___ _ -,�_} ype•_ _ -_- ______�Material_ __!. �. (Compartments _�_��.-�------ _0 .___ .c____ _ Prop. Line ------------ 4 _________ Distance to nearest: Well ---_---- ------------------ /' --------- p. LEACHING LINE No. of Lines r_—.F---- --"""_'Lengtk of each-• ine___"_�_�-L�_._.______ Total Length ___�-�_Q._. --.-.-- p' Box _____✓ Type Filter Material 14 ____ --_Depth Filter Materia! __, _ ____________________�____._... Distance to nearest: Well ____„5--- ----------- - Foundation ___ �______________ Property Line ____ ______.__.___._.__. SEEPAGE PIT [ ] Depth -------------- ----- Diameter _`---_--_-_--__ Number.`---------------------------- Rock Filled Yes ❑ No I❑ i Water fable Depth . -----------------------------Rock Size -------------------------------- k Distance to nearest: Well _--__.___ __________________________Foundation -------------------- Prop. Line __--....._______-___-- i REPAIR/ADDITION'{ rev.Sanitation Permit# -------- ----------------------------------- Date ----------------------------------- Septic _--_--_-k_-___________---------_Septic Tank (Specify Requirements) ---------------- -- -----------------------------' -•----------•-----•-------•------------------- --------- Disposal- Field (Specify Requirements) ------------------------------•------------------------------------------------------------------------------------------•----------- ------------------- 1 -------- -------------------------------------------•-- ---------------!, ----- --- (Dr-aw.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 Wissued,.I.shall.not employ any person in such manner as to become subject to Workman's Compensation laws of California." - i Signed ---------------------- ---------------------------------------- Owner r -------------- Title -------- I------------------------------------------------ Fif o than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -, ------ - ------ -------------- --------- ---------- DATE -26-_7Z. BUILDING PERMIT ISSUED ------ - ----------- DATE ADDITIONALCOMMENTS - -------------------------------------- ---------------------------------- ------------------------------------------------------------------------------ _ . , _�. _ . _ -------- == '" "---=�'"'"----------------------------------------------- .v ------ , ------------------------- ---- -----------------------------I------------------------------- X ---------------------- - --- tSAN�EAQIJ s- - ` N. x Final Inspection by - -- -------- Date .r - 1[v LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M