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OR OFFICE/USE: APPLICATION FOR SANITATION PERMIT Permit No. • (Complete in Triplicate) Date Issue This Permit Expires 1 Year From Date Issued Application is hereby mode 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 County Ordinance No. 5A9 and existing Rules and Regulations: Aga G� JOB ADDRESSYLOCATION Owner's Name ----------�------------- - - -- L -----------CENSUS TRACT -------------------------- t' ----------------- �'�� • �� ' Phone - city 4-k- ---- -------- Address --------- ---------- � / . Contractor's Name --- --- _ License # --,f - Phone --- -------------------- ------ Insfiallation will serve: Residence' Apartment House Cpmmercial : Trailer Court ❑ 'rA1r4 1 M tel ❑ Other _._ -- jl !_ •--- e J - Number-of bedrooms _____Garbo a GrinderN-�---- Lat Size _-. ot'Tjl1 -- �-rte ., Number of living units-.- -g Water Supply:'.Public System and name ----------------------- ----------------------------------------- Private J ; Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay E] Peat El Sandy Loam El Clay-Loam [IJI 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.) r - NEW It {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / _ --- _ - Liquid Depth --------- + PACKAGE TREATMENT ) ] SEPTIC TAMC zex �,' I � � q P .�.s; Capacity _Z ---:-- Type Mate iral_ OYl _rNo. Compartments ___.__ ..� _ :r._.r �- Foundation f--Q ----------- Prop. Line __ t ---Distance to nearest:)Well ___�_.(}- - 1 9 ' , ? __ Len th of each ;line--- -(- _ Total Length 'E,� ---------------- ,LEACHING LINE 1 ' INo, of Lines,.- -� --- -- 9 /i D' Box _ �S Type Filter Material Z v_hV pth Filter Material -- - ---.-----------•-----•- 10V / —_ Pro e ime-;: " ---- —Distance to'nearest"Well k_ --___--.-- Foundation- -."=--- - p dY" " J ; ''/ ---_--.-- Rock Filled Yes `' No C] - piameter 1 SEEPAGE PIT [� Depth` ---- -- -�----- - Number -------- ------- y X.� Water Table.,.Depth_._ J�4 Rack Size -- YI i Foundation / Prop. Line ..�-------------- Distance to nearest. Well --_____/--__-_.__ 1 REPAIR/ADDITION(Prev. Sanitation P,efmit# -`------ ---------------------------------- Date ---------------------------------- Septic Tank (Specify Requirements)----------------------------------- ------------- --------_----------------------------- ,Disposal'_-Fieid-_(Specify--Requirements) ----- --------------------------- ------ --------------------------------------------- ------------------------------------- k i 1: --- --------------------------------------------------- ' i. (Draw existing and required addition on reverse side) 1 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- sed agents signature certifies the following: "I certify that in the performance of Lhe work,f0 hich this permit is issued, I shall not employ any person in such manner as to become subject to Work Compensation laws of California." - ,. , ;.;; ----- -_. --- Ow nerSigned --------------------- _ ---- ---- --- -------------- - ;--, ----- --By - ----------- -----------• Title ------------------------------------------ (if � " -------------------- (If of han owner) 1 FOR DEPARTMENT USE ONLY' APPLICATION ACCEPTED B = t -- ------------ DATE BUILDING PERMIT ISSUED --------------------------- ----------'�------------------------------ - -------- DATE --- - - - --- ------ ADDITIONALCOMMENTS ------------- ------------------- ------------ l--------- ---------------------------------------------- 1:, ' --- .d - -----------------' — — ----- ------------------------- - - 3 --------- ----------- ---'------------------------------------- - - ------ — - - ----- _ :Final Inspection by: -- ---------------- ----- :- ----- ------------------ - Date -10-- x- SAN D-ra"- SAN JOAQUIN LOCAL HEALTH DISTRICT �. E.'H. 9 1-'68 Rev. 5M,