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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �j y Jx G� Permit No. - -1- (Complete in Triplicate) ---------------------------------------------------------- . Date Issued -l-•--1---�..�9 - This Permit Expires 1 Year From 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:' i _ �fi ---------------------CENSUS TRACT --------- ----------- JOB ADDRESS/LOCATEON :----/_-%-_*�------ ._� - ---- -- v Owner's Name Phone r ------------------------------------- re -__ � ./�- ----- --r- - tY ----- - /� �� [� License # __ __ Phone -- -------------------- Contractor's Name - - -- ----••-- ---��7�----"f4- ----��'"�`-.- Installation will serve. Reside nce�Apartment House❑ Commercial :❑Trailer Court ❑ Number of living units:-_ 1__---- Numbk Motel b❑edrooms7__c_.;Garbage;Grin 1ert_ �;--__c. Lot'Size � � f i Nu g � i � V Water Supply: Public System and name _ _____ _ _________________ Private Character of soil to a depth of 3 feet: Sand,'❑ Silt❑ Clay ❑ Peat ❑ Sandy Lodm -[j Clay Loam El tit � �:� -� .�..... . �_w,.""" E Hardpan ❑ -Ado6e�: -+Fill Material,-__-,_--- ,)Byes, type---;-;;,__----------- ---- (Plot: plan, showing size of lot,{locati&i i f'sy-stem in r ation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT SEPTIC TANK:[ ] Size------------------------------------------------ Li Depth ------------------- ------ Liquid CapacitX Type - ------ ----------- Material--------------- ------ No. Compartments ---------------------= r Distance to nearest: Well -------- -- - --------Foundation ---------------------- Prop. Line ---------- ----------- - I LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-____ ---------___-------- Total Length :-----_-__---_---_ 'D' Box ----------.- Type;-Filter Material --------------------Depth Filter Material ----------------------------- ----- ! i Distance to nearest'Well ----------'------------ Foundation ------------------------ Property Line -------------------=---- _ p SEEPAGE PIT [ ] Depth - -------"x -- Diameter - ------------- Number ---------------------------- Rock Filled Yes E] No ' # Water Table Depth 1 Rock Size __---------=------------- ----- ' Distonce.to nearest: Well -------------_--------------------------.Foundation -------------------- Prop. Line ..-------------__-- { ,REPAIR/ADDITION(Prev. Sanitation F e Permit# ------------4-.- ---.'-_--a-.---Y� i -- Septic Tank (Specify Requirements) ) # Disposal. Field (Specify Requirements) - /1V . -- ---------------------- ------------ ddition or+ reverse side) (Draw existing and required a ----- --- I he certify that I have prepared this application and that the work cwill be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health Distrect. Home owner or licen- sed agents signature certifies the following:_ , t r F - I "1 certify that in the performance of the work for,which this 4ermit`is issued,�l shall not empYoy any person in such manner as to beco ` �d�km 's Cqm ns do laws of,C lifornia." -� b`^� 5 Signed -------=-�- ----- ner•..,�...�.,.�... t f- -- (If _ Title ------------------------ -------------------------- (If other than owne FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ---- DATE ------ BUILDING PERMIT ISSUED --------------------------------- ----------------------------------------------------------------- --------------------- -- -- - ---DATE ------------------------------------------- ADDITIONAL COMMENTS -------------------- --- ------- ------------------------------------------------------------------------------- =----- -------------------------------------------------------------------------- -------------------------------- - -- --------------------------------------------------------------- --------------------- , �G--------------=------- Date � -------------------------------------Final Inspection by SAN JOAQU.IN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.