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FOR`OFFICE USE: o -,IPLICATION FOR SANITATION PEh. 7 3—/33 �....'<17 3 - -��"T Permit No. (Complete in Triplicate) ------------------------------------- �3 �,� Date Issued _�-__.._�__.. This Permit Expires 1�Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---MDQ-. !�/•-- - _ � a'`-.; -CENSUS TRACT -------------- ------ Owner's Name ---- / ---------------------- ------------Phone --- � �__., Q "Z'__Address e,06- / ".f � ------- ----------------------------_. City Contractor's Name __- l' License # 1� Phone _t`1 __ r Installation will serve: esidence ❑ Apartment House,17 Commercial ❑Trailer Court lQ Motel XOther ! �'Qt-- ` .tee.=---*-- Number of living units:__---_-___. Number of 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 TR9ATMENT [ ] SEPTIC TANK:[ ] Size------------------•-------------------.--------- Liquid Depth -------------------------- 00 Capacity ------------------ Type -------------------- Material---------------------- No. Compartments --- ---------------•- /r G Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- 0 LEACHING DINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ----------- -_-- �,r�fA4 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------------------------------------• !!� Distance to nearest: Well ------------------------ Foundation ----- ``----._____------ Property Line --_____.__________.--_-- SEEPAGE PIT [ ] Depth -F___ Diameter __ ��--_ Number ---------l--__--_._______ Rock Filled Yes No [3 . Water Table Depth ------------ _r------ -----------------Rock Size ----c Distance to nearest: Well -------- Qp---------------------Foundation ---- Prop. Line ___ ---.---. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------- ---------- ---------------------------------------------------------------.':---------------- �r .... Disposal Field (Specify Requirements), -.------- = "" x' -------------------•--------------- - �--� J-------e�-G= r� J -� -------------------- ------------------------------------------------------------------------------------------------------------------------ (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 wish 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 jest t Workman's Compensation laws of California." Signed CIL_ ---------- Owner By -------------- ---- -- --- ------- Title ' (If other than owner) FOR DEPARTMENT USE ONLY .- APPLICATION ACCEPTED BY . 41---- -- --------- ��------------------------------------------------ DATE --- • - •- - 't/ BUILDINGPERMIT ISSUED ------------------------------ ------- ---------------------------------------------------DATE -- ---- •--- ADDITIONALCOMMENTS ------------- ----------------------------------------------------- ---------------------------------------------------------•=---------- ------ --------------------------------------------------------------------------------------------------------------------------- -----------------------------------•---------------------•-------- ----- ---------------- ----------------------------------------------- --------- ----- - --- ---------- ------- -------------------- ------------------------------------------------------.f-- ---------------•- ------------------------------- ------ --------------- ----Date Inspection by: ------- --- - E. H. 9 1-'68 Rev. 5M tr