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FOR OFFICE USE: ` 7 i eAPPLICATION FOR SANITATION PERMIT r -- il '� p (Complete in Triplicate] Permit No: _44_f7, - f.� �. .------------------------ --.cam > Date Issued _Y_-/__-6 g This Permit.Expires 1 Year From Date issued Application is hereby made to th San Joaquin Local Health District for a permit to construe t and the work described. This application is made in compliance with County Ordinance No. 549 and existing Rulestalnd Regulations�eFn JOB ADDRESS/LOCA?ON - " -" ?jtJ i. ---------- ---------- - ------ CENSUS TRACT Owner's RACTOwner's Name ti Address -------------------------- one . Z2// �- "-------- Cit Contractor's Name --__ _ `TSS t License # -7- 3- Phone-q �'2 7 Installation will l serve: Residence E]Apartment House'❑ Commercial:❑Trailer Court ❑ # Motel ❑Other --•------------------- ---------------------- Number of living units:------- -.__ Number of bedrooms+ --�-_-.Garbage Grinderiye sj---___ Lot Size "-$d_-_ �_ - �c.� - •-- ------------------ Water Supply: Public System and name ----------------------f c ----- Private ❑ Character of soil to a depth of 3 feet: Sand'❑, Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ r Hardpan ❑ Adobe R'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 [ ] -.__--._- Liquid Depth -------------------------- \( Size-- f a Capacity - -----------------t Type - --- - Material--------------------- No. Compartments Distance .to nearest:i Well ------------------------------------Foundation ---------------------- Prop. Line ---------------- LEACH LINE ,a . [ ] No. of Lines ----------------- ------- Length of each line---------------------------- Total Length .------------- D' Box ------___--_ Typ Filter Material --------------------Depth Filter Material --_ _ _. ._--__- Distance'to-nearestWell ----- ----------------- Foundation ------------------------ Property Line, ---------------- SEEPAGE PIT [ ] Depth ..,_� Diameter Number ___ Rock Filled Yes ❑ No a0 - - ---------------- Water Table Depth -------------------------------------------- Rock Size -------------------- LNk -Distance to*nearest:�Well _--.-`_____________ _________ __ Foundation -------------------- Prop. Line --------• -=------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ---------------------------- Date ) Septic Tank (Specify Requirements) __------_--------- ----- ---- ---------------------------------------------"----------- Disposal Field (Specify Requirements) -_-_- - ------------------------------------------------------------ ---------------------- -------------------------- --------------------- ------------------------ - ------------ ------------------------------------------------------------- - - -------------------------- certify that I have prepared existing and required addition on reverse side) I hereby p p fd this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and.Rules and Reguiations 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 subject to Workman's Compensation laws of California." Signed ....___.- . BY ------------ --------- ----- ------------- Title -------------- (lf other than owner) ------ --------------------------------- FOR -------- ----------- ---------- FOR DEPAiRTMENT USE ONLY APPLICATION ACCEPTED 8Y .-- a- - DATE ----------- BUILDING PERMIT ISSUED ___/_ ___ ___" ADDITIONAL COMMENTS /' -_Cf_ DATE `� ---- --------- ------- -------- ------------ - �� -------- ----------- -------------------------------------- ----- ---r�-�------p�..J-------- - -------------/------------------- ------ - -- --- ----------------------------------------------- ' -- -------------------------------- ---------------------------------------------------------- ------------------------- - - -ina Inspec- - tion by: -- ��--------- --------------------------------------------- ------------------------------------Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM