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FOR OFFICE USE: �. 9 3 e APPLICATION FOR SANITATION- PERMIT ---1��/�I "�' -----.`--------�-=--- ---------- �. �--�--��. (Complete in Triplicate) Permit No. --------------------------------------------------------- This Permit Expires 1I Year From Date Issued 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/LOCATIO ----t'iL�--- _--'----- ------------------CENSUS TRACT ------------------------.. !� - - w -- ------------------------------ Phone ------------'------- - Address L__-"�-' --------------- -- --- -- -------------- --- Owner's Name --- City -- ---------3-----"•---•---•----- f - - f nz Contractor's Name -----------C-�----1� -_- --------� -•---------.License #42 fG � ` Phone60- � - Installation will serve: Residence [`Apartment House-E) Commercial :❑T�ailer Court ;❑ Motel E] Other --=-------------------- Number --`-------------- Number of living units:_-_! __ Number of bedrooms __�e_-____Garbage Grinder ------------ Lot Size —-X,7y��-- -- ` 'tie' �_r _ Water Supply: Public System and name ------= » Private { Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe; ' Fill Material ------------ If yes, type -------------------------`__ �i `(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,)I . PACKAGE TREATMENT [ SEPTIC TANK Size___,6� .41___/1_�_✓__0---- ------ Liquid Depth ------S......------ Capacity/tl?P__�:IWType _ 'Material_--404LxNo. Compartments !- ______________ f . Distance to nearest: Well ------- --------------------Foundation __f __ _____ Prop. Line ___° �___ _______ LEACHING LINE [, No. of Lines ------�_----------- Length of each line--------47,.5- ------ Total Length ............ 'D' Box -__!__---- Type Filter Material '-__------Depth Filter Material -_1 ------------------f__-_._....-_ ------- Foundation - --- ------------ Pro , ' Distance to nearest; Well __��___ .� party Line +:'�`__________ SEEPAGE PIT 7 Depth _� _�_ Diameter ---�_ Number ___ .__.____________ Rock Filled Yes No ❑ -- . w. Water Table Depth ------ Rock Size ------•-------- Distance to nearest: Well ----.-� q_'`-----------------Foundation -.__ Prop. Line ---------------------- ------- .-- -_---..__ REPAIR/ADDITION(Prev. Sanitation Permit# ________________________ ___-__ - Date - _--__-----._____ ---------------I SepticTank {Specify Requirements) ----------------------------------------------------------------------------------•------------------------------------- ------------------- DisposalField (Specify Requirements) ---- -------------------------------------------------------------------------------------------------------------------------------- � y ----------------------------------------- _ t -- ---- ------------------------------------------------ (Draw existing and required addition on reverse side) .- �»-_.. I hereby certify that I haveprepared 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: i.-.r- j; "I certify that in the perFormcnce of the work for which this permit is issued, 1 shall not employ�!ny`person in such manner as to become subject to Workman's Compensation laws of California." �' ? Signed ---------- Owner -� -- ---------. . - - E BY --------------- _--- ---------- .-----�`7 _ u . ----------- Title ��""��"� ---------',- -- (if other than owner) FOR RTMENT USE ONLY t . E - - ' APPLICATION ACCEPTED BY -1----- ------------------ ---------------------- -------- DATE ---- = /-------------- BUILDING PERMIT ISSUED DATE - = - -- - -- -------------- ----------------- Di IONAL COMME TS ' ------ -- --- ---I—---------------- '----=-,•----------------------- �..� ---� ----------------------------- ---------- - - - --- ------ -- --- -----------------------------__:_-------------------------------------_--- ------ ----- Final Inspection by..' "" - - ----- -=------------'- ----------------------------------------------.-Date --- Q----f----- -- - SA�JOAQUIN LOCAL HEALTH DISTRICT.— .., E. H. 9 1-'68 Rev. 5