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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- (Complete in Triplicate) Permit No. Date Issued =------------------8 -----------_------- ------------------------------------ This Permit Expires I Year From Date Issued Health District for permit to construct and install the work herein Application is hereby made to the San Joaquin Localp described. This application is made in compliance with County Ordinanc No. 549 and existing Rules and Regulations: JOB ADDRESS/LOA ON -- _-- )---- - --- --4-----------------CENSUS TRACT -------------------------- � . Owner's Name ------------- 'Ef --------------Phone 3-6.-=---77/- I- ��...,DD Address -------------- � ---- ------------r------ -- ---- ----- �7--- -------- City ----- '�----------------------------------------•------ Contractor's Name hTi-,r.YF d "�'�'�* ------- Phone �F�--- j�`'/ .License # Installation will serve Residence ❑Apartment House-E] Commercial ❑TralIer, r ❑ Cou_ t l Ml te Number of living units:------------ Numberoof bedrooms ------------Garbage Grinder __._ ------- Lot Size ----_-�_ �---------- Water Supply: Public System and name ----------------------- --- -------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe '❑ Fill Material------------- If yes,type -_-.______________________ (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,) .PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size-----------------------------------•------------ Liquid Depth --------------------,----- F n Capacity -------------------- Type -------------------- Material-------- ------- No. Compartments ----------------•----- " Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------••-------••-- :.� i LEACHING LINE No. of Lines --------/------------ Length of ach line-',/Q@_--------------- Total Length ,-�� ---..------------ 'D' Box ------------ Type Filter Material __ _ - _ _-___Depth'tFilter Material ---------/-Y _________________________ Distance to nearest: Well/-.0,146-_________' Foundation __— rt__ Property Line, /-V-- ------------- SEEPAGE PIT )[+] Depth ------ -____ Diameter -A?------- Number ---------/--------------- Rock Filled Yes � No C3�..._ , S,Water Table Depth ----------------6-0----`----------------'=-Rock Size - �]- ----------- le I 1 a---------- Distance to nearest: Well ��____________________,__Foundation .___�5✓ _____ Prop. Line _. REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------- ---- Date ----- -------------------- ------ Septic Tank (Specify Requirements) ---------------------------- ------------------------------- . i Disposal Field (Specify eq irements) _____ --V---- y- � . ----------------------- --------- --- ------------------------------- ----------------- ---- -------------------- ------ -----`-------------------------------------------------------------------------------------------------- =----------------------- ------ --------------------------------- (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 Sart Joaquin Local Wealth 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." Signed ------------------- ------- r------- ---------------------------------- Owner BYY�/ Title {Ifo er than owner) •.,� 4FOR DEPARTMENT USE ONLY � f APPLICATION ACCEPTED ------------------------------- --------------------- DATE _ ` " BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------=--------------DATE ----------------------------------- ------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------- ''=- �------------------ --------------------------- --------------------------- ----------------------------------------------------------------------------------- ----------------------------------------- ---------------------------- ------ --------------------------------- ------------------------------------- --------- ---------- Final Inspection by: Date _..+ _ -__j - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M