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' t,Ff10FFICEJAPPLICATION FOR SANITATION PERMIT fiPermit No:---- (Complete in Triplicate}p Date Issued----------------------- '" This Permit Ex ires 1 Year From Date Issuedi f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein f described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ` y CENSUS TRACT ----------------- -------- JOB ADDRESS/LOCATION . �/ --- --� ------/-�--/%fix_ ---------------------- -- ------------ ( Phone 0 Owner's Name --- Address ------� -- ----- ----- ------------------------•--. City. ; Il e Contractor's Name _ __.License # � - Phone `. -_Si 1 , . . . Installation will serve: Residence-3 Apartment House❑ Cp mmercial ❑Trailer Court .D l a,1�Ichw„c.----------------- Motel ❑Other _.l ------- 10- . . Number of living units:----/- /� �--- Lot Size ._1�f�--�'L",f'------------------ i ----- INumber of bedrooms --__.___Garbage Grinder Water Supply: Public System and name _________________________________•..-_-_-- - Private. � Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat[:1Sandy Loam ElClay Loam 'Ll Hardpan ❑ Adobej', Fill Material _.____----- If yes,type ------------------------ I I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewe is available within 200 feet,) { .1 / /i i W Size____ -_. __ -- Liquid Depth __5 ----------------- PACKAGE TREATMENT [ ] SEPTIC TANK -f - / _--_. Capacity/9-00-1f414- Type __ Material_G� 'No. Compartments 9------------•_---- � " _�___.____-___ -Foundation -- j�"-e----------- Prop. Line Distance to nearest: Well ____3 __ _�--;:--••---- LEACHING LINE [� No. __ __------- -- --_ Length of each line__/06)_--------------- Total Length _10-0.:�.-------•-- of' ______ 'D' Boxl./VO--__ Type Filter Material _�B_G/C----.Depth F;Iter Material _� ---------------• Distance to nearest: Well -------- ----- - Foundation __-!A-(------------- Property Line ---- -------•--• _ Number ___._� Rock Filled Yes No SEEPAGE PIT Depth - _.571--_-- -- Diameter` - �� , Water Table Depth _____r�0_�------ --------------------Rock Size .� -- --------------•- Disfiance to nearest: Well _____/ �- -----------• -------Foundation -- --------------- Prop. Line - --..-------------R.. ' --------------------------------------------- Date --------------•-------------------1 REPAIR/ADDITION(Prev. Sanitation Permat# - _ - I ---------------------- F Septic Tank (Specify Requirements) ---------------------------------------- ----------------------------------------------------------- I Field (Specify Requirements) --------------- ---- ---------- -"""---- - ---------------- ------------------------=--------------- ------------------ ------ -------- -- --------- - r Draw existing and required addition on reverse s( e} 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- 1 sed agents signature certifies the following: k for which this permit is issued, 1 shall not employ any person in such manner "I certify that in the performance of the wor as to become subject to ork 'an' Compensation laws of California." k Signed -------------- ------------------------------------------ Owner ------ --------- -- rTitle ------ ---------- --------------------------- ---------------------- -- ----------- --- ---------------- -------------- ------------------------ - (I er th n o ner) FOR DEPARTMENT USE ONLY I ' } DATE 7 APPLICATION ACCEPTED By_----------------------- -1-- � BUILDING PERMIT ISSUEDt ------------------------------------------------ ADDITIONAL COMMENTS ------I--------------------- -- ----- ------------------- -----------------------=--- - ' --------------------------------- -- - ------- -- ----------- - --------------------------------------------------------- - --- -------.Date --- ---- -- - ------------ Final Inspection b ----�---- -------------- - SAN JOA UIN LOCAL HEALTH DISTRICT C F. H_ 9 1-'68 Rev. 5M