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� �--�- AOR OFFICE USE: ' -�------ ---��------- APPLICATION FOR SANITATION PERMIT '= ----- .-- ------- ---- ��----. ..Per E_.'•��`-��/ {..,_. (Complete In Triplicate) mit No ............ ..... This Permit Expires 1 Year From Date Issued 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 compliant with County Ordinance No. 549 and existing Rules and Regulations: �.y JOB ADDRESS/LOCATION . .-- 4..1..-- -- `-`-'�-� .-7_ -•--CENSUS TRACT Owner's Name --- ------ . Phone ----•- •--------- Address ------- - � - - City -' - Contractor's Name --------- ---------------- ---------------------------------License #/90S//-------- Phone Installation will serve: Residence Apartment House'] Commercial OTrafler Court Motel ❑Other ----------------............................ Number of living units:...)_--.... Number of bedrooms -3------Garbage Grinder -------- -- Lot Size ------ � Water Supply: Public System and name .-----.-----------I'll..- ----------------------------------------------------- _? ------•---- ------••----------- Private Character of soil to a depth of 3 feet: Sand❑ Silt p Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam E] II Hardpan Adobe W 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 ,.,I ] SEPTIC TANK ize-..... .-y ,• :f �-`--�--------•----•- -- ---.. Liquid Depth ..sy.............. Capacity� -. -- �OF 9- ------- Type -... Material. .r._ No. Compartments ... I Distance to nearest: Well ..... ..- .................Foundation -----eQ------....._ Prop. Line __.-dam.- 1.f LEACHING LINE' No. of Lines / ----��-- ------------ Length o�fJeach/� line..... -.-.-..----- Tota! Length --��---_-•-_• _-- D' [3ox .._-L Type Filter Material Yeo.............pepth Filter Materialt ---- ----- ----- - - Distance to nearest: Well ..'0.114-------- Foundation /O ' — - Property Cine Iff SEEPAGE PIT Depth ._7_5..-..._. Diameter -33- ------ Number -------------- Rock Filled Yes X No �] Water Table Depth -______' -------- ------------�----- ----.......Rock Size Distance to nearest: Well _._.f ------- - --------Foundation ..fU-- "---. Prop_ Line ., REPAIR/ADDITION(Prev. Sanitation Permit# ----- ---- -------------- Date ...................... ----------- i Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ----------------------- --------------- -- ----------- ---- ----_- ----------- -------------- ------ 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: 8 "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 b6come subject to Workman's Compensation laws of California Signed .. Owner By ....... _ Title ... - ....... o er n owner) - � t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..._. - .... _- DATE ... ------ ------------ ............ .................... ----- BUILDING PERMIT ISSUED ......................... . ---�--- ----- ---- ...--.----DATE ADDITIONAL COMMENTS .---- --�-- ----------- ------- ---- --------------------- -------- ........ ...._._..-.--- ...._....... - ... --.-- ----- ina Inspection by: ----- - --- ------------ Date . SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M