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FOR OFFICE USE: ------ - _.__413 _- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: . 1I. Date Issued -. _5 �'-- 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 County Ordinance No. 549 and existing Rules and Regulations: lY. E , JOB ADDRESS/LOCATIONIII ------ _ -��/� _ f � CENSUS TRACT --------------_-•---_-_--- Owner's Name -----� I"-:D 4"?f S ---------Phone City Address ---- � '� �/. -! r .'. ------------- c} --- �f�- -•-••--- Contractor's Name ------License # ..� _!z�!73---- Phone Installation will serve: Residence Ej Apartment House Commercial [:]Trailer Court Motel E] Other�J : Number of living units:-.2_- Number of bedrooms --�---Garbage Grinder ------------ Lot Size -_ Water Supply: Public System and name - - -�-t._ --------------------------------- --------------------Private [1 Character of soil to a depth of 3 feet: Sand'o ilt Clay .El Peat❑ Sandy Loam E:] Clay Loam D Hardpan Adobe Fill Material ----- If yes, type ---------------------------- (Plot ---_______________ ___(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 feetj PACKA E TREATMENT �` [ ]I SEPTIC TANK[ ] Size ------ Liquid Depth -----------••------- -- �}/(51"oj? Capacity --- ----------- Type -------------------- Material No. Compartments -----------•• /� ------ Distance to nearest: Well ------------------------------------Foundation -----_------------_- - 1 I _ Prop. Line ----------•----------- LEACHINP LIME [ ] NJ' of Crm'--0- s -- _____________ Length of itch line_--__ ` f�------------- Total LengthC� t5 T sicl 'D'IBoxEf �K Type Filter Material j�_�_�__-Depth Filter Material --___` -------------- Distance to nearest: Well -_ ifj _ __ Foundation -- _t?_----- ---- Property Property Line ' SEEPAGE PIT [ ] Depth -�---11 �jj! _ --- Diameter _ L--- Number -----___-_/---___-_-__- Rock Filled Yes No �] i Wafer Table Depth ---__ - r -----Rock Size _- > f.y Distance to nearest: Well _.- -------------------Foundation .- _______ Prop. Line --_- ._ . REPAIR/ADDITION(Prev. Sanitation Permit# _.-_-_--..-__---_-_-_-------__------------ Date -------------------- --------------1 Septic Tank (Specify Requirements) ----------------- - - Dlsp , Field ISpecif a u�rementsl - _ - { a - - C ------------------------- ------------------------------------------------------------------------------------------------- �` (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 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 perform'a'nce of the work for which this permit is issued, I shall not employ any person in such manner as to beco s ect to orkman's om nsation laws of aiifornia." I Signed ---- ----- ------ - Owner - ---- -- - - -- -------------- (if BY - Y`- ot t o,' -- -- ----------------- Title -- ned FOR DEPARTME USE ONLY :,F f APPLICATION ACCEPTED BY--.--- BUILDING PERMIT ISSUED ---��______________ ----------- ------ DATES/ i - ------- -------- - DATE ADDITIONAL COMMENTS ___AI------------------ ------------ -------------- i -------------------------------------- ------------------------------------- ------------------------------ P Y ----------------------------- --------------------------------------------------------------------•--------------•---- ------------------------------------------------------------------------ -------------- --------------- Final Inspection b - �J --------- --------------------------------------------------------Date ___10- -- -1 - ----°------ ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. 0