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..FOR OFFICE USE: 1 F APPLICATION FOR SANITATION PERMIT --------------- ----- (Complete in Triplicate) Permit No. -- ---__-__-l. Date"Issued ,p2_-a28=.z ----------------___________---------------______-______ 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 C unty Ordinance No. 49 and existing Rules and Regulations: JOB ADDRESS/LOCATIO __ - t ---=--- ------ - S TRACF -------- •--------- r .� I Owner's Name -- ------ Phone el Address ---------g-_ City ------------- Contractor's Name _-- �.-- - ----- -- -----License Phone F` .p Installation will serve: ' • Residence Apartment House❑ Commercial :❑Trailer Court :Ljr. t Motel ❑ Other Number of livingunits:___ Number of be room j ----- ____Garbo GrinderL-�._ Lot Size -_/_ .-�_�______�___ _______________ Water Supply:jPublic System and name ------_'��q -------------------- Private ❑ Character of soil.to a depth of 3 feet: Sand [] Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe'A' 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 [ ] Size6_______________ --------=-------•------------ Liquid Depth ------------ ------------- Q, Capacity ------------------F Type -------------------- Material------------------- -- No. Compartments ——Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------------_------- � ---.�______________ Length of each line_-_-_- __ .� LEACHING LINE " No. of Lines g -- -----_____ Total Length __ _ ____________ -'D' Box _,�_____ Type Filter Material _ ....Depth Filter Material ---� �� .___________ Distance to nearest: Well__- __- -.._ Foundation ------------- Property Line ____---. SEEPAGI_ PiTDepths 5___________- Diameter __--__ Number ____�_________________ Rock Filled Yes ENo i❑ t rt Water Table Depth -----�tf -------Rock Size __, ----- Distance to nearest: Well ---/r.2P_-------------------------Foundation ----------- Prop. Line .IS....__-....... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ------------------------------ Septic _______________r________-._Septic Tank;(Specify Requirements) T- --------- ------- ----- Disposal Field (Specify Requirements) - - c-cJ}----------------------------------------------------•----------- --- --------- ------ ------------------------------------------------------------------------- --------- ------- ---------------- -- I.,,,,� (Draw existing and required addition on reverse side) �h 1 hereby certify. that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Strite 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 this permit is issued, I shall not employ any person in such mannet as to become subject to Workman's Compensation laws of California." Signed --------------- --- --- ---------- ---------- r Owner BY - --- ----3 - _— ---------- Title C (If other than'owner) - € FOR .DEP RTMENT USE ONLY ------------ APPLICATfON ACCEPTED BY -_ -.///- DATE BUILDING PERMIT ISSUED - --------- -- - --------------------------------------------------- ---DATE ADDITfONAL COMMENTS - -_________ --- --- -------- - -- - - -----------i----- - Y r --------------------------------------------- ------ - - ------------ ----------- ------ -------------------------------------------------------------------------------------- - Final Inspection by: = =------ --------------- - ------ SA JOAQUIN LOCAL HEALTH DISTRICT » E. H. 4 1-'b8 Rev. R