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FOh?`OFFICE USE: - ---- ---------- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _-3-1------ ?J ---------------------------~--- This Permit Expires 1 Year From bate Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work described. This application is made in compliance with County k herein p t Ordinance e No. 549 and existing Rules and Regulations: JOB ADDRESS LOCATIO / �--- ------ -- -�- - -- .lfil----- - 4" ''�.-.. - ENSUS TRACT Owner's Name - ---- a ----------- --•----------- 0 - - - ------ - - -----Phone ----------- ------------ Address __ __- -_ _a�- - ___ LL ---------- ------------ ------------------------------- Contractor's Name _ - -- _ License # ZZ� - "'-_ Phone ------- Installation will serve: Resi ence Apartment House❑ Commercial:❑Trailer Court ;❑ Motel ❑Other Nu tuber of iivin units:_ -_ -- Number of bedrooms _- Garbag a Grinder __--------- Lot Size ______- --------- WaterSupply: Public System and name --------------------------------- ------------ " - --------------------------------------------------- - _ Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe ❑ Fill Material ------------- If yes,type ---------------------------- (plot -_____-- -_(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 ublic sewer is available within 200 feet,) S PACKAGE TREATMENT [ SEPTIC TANK'[ Size, -;t! `.�' �_ ```` - -- -- ------- Liquid -7�----- ------- Capacity�. TYP - ` ,)--- Material__ No. Compartments r-- P --c�---- t Distance to nea st: Well J-O ! -- c Foundation' - �� Prop. Line --- LEACHING LINE [k1l No. of Lines ----------__ Length of each line-------/.f;"?O------------- Total Letngth __,;Z. --a--- Type .Filter Material ---IS- _ - I _-_3--.Depth Filter Material _-- -- �-------------------- _ �.�. �.. ,., Distance-to :nearest::Well Foundatibn=___ =C3�r."°�"4Prope Line SEEPAGE PIT � � /r -�-' [ Depth. — ----- Diameter ----33 Number -----_- -r.�----f----t--- Rock Filled Yes � No � Water Table Depth ---------------- Q__`----------- - -------Rock Size Distance to nearest: Well Cly--_-------------- Foundation ....�_©- r------ Prop. Line _ --------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------ ____-- E ) Septic Tank (Specify Requirements) -------------------- - t ---- -------------------------------------------- -- isposal Field (Specify Requirements) ---------_------------------------- ---- ---------- ) - --------------------------------- --------------------------------------- -------------------- ----- --- ------- ----------- -------------------------------------------------------------------------------------------- - - ------------ - (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: `11 certify that-in the performance of the work for which thiperm t is issued, I shall not employ an - as to become subject to Workman's Compensation laws of California." P y y Person in such manner Signed ----------------------------- ------ ------- Owner By -------------- ------------------ - ` -- Title --- - - (If other than owner) ---- - -------- -------- -------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _-- BUILDING PERMIT ISSUED - --------------------- ---------- ---------. DATE _"_ -_ "-- -- - ---------------- ADDITIONAL COMMENTS --------------------- - -- -- - - ----------------- - ---------- -------- -------------DATE -------------------------------------------- ------------- •----------- -------- ---------------- ----------------------------------------- - -- --------------------------------- Final Inspection by: ------ ----------------------------------------------------- ---------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,