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FOR OFFICE USE: APPLICATION FOR'SANITATION PERMIT 6f-�. / --------------- -------�� 3Q--- Permit No- ------------ (Complete in Triplicate) , ------ _ Date Issued ---___`Z1---6. - 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: �S - JOB ADDRESS/LOCATION ------ °-- - - CENSUS TRACT ----------------- -------- • ��/ O Owner's Name G� -- Pane _ _ g �j►,� 3 City -�� - --------------------------- - Address L.ti- ------ Z-- / _ __ --- License #��'�-477Phone ��-�--��----r-��--- Contractor's Name ____ -------_. __ Installation will serve: Residence;KApartment House F-1 Commercial ❑Trailer Court [Ii Motel E]Other -------------- ---------------------------I Number of living units:_-___�_ Number of bedrooms __"___Garbage Grinder-_G-__ Lot Size _��-- ----• eX E Water Supply: Public System and name _________________ ___ __ _ Privat Character of soil to a depth of 3 feet: Sand'❑ Silt F1Clay ❑�. Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ '-Adobe ❑ Fill Material,_______-___ If yes,type ---------------------------- [Phot plan, showing size-of lot, locatign 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,) / (n SEPTIC TANK Liquid Depth .'------ ------- PACKAGE --• -PACKAGE TREATMENT [ ] Ca acit TYPe Material_ -_-- No. Compartments ______________ e 11 f -----Foundation -16------------ Prop. Line _�.._-. -__-••- - Distance to nearest: Well ___�..J�----------�------- LEACHING LINE No. of Lines ___ ________ __ __ Length of each line-----G.�, ____ Total Length �t 'rte ......--•- { 'D' Box ___________ Type Filter Material 5l�1�Depth Filter Material ____ ----------------11 -----!-•- � / 1 Distance to nearest: Well ------- Foundation f--U _ Property Line .............. .. t _______ Roc/ Filled Yes No 0 SEEPAGE PIT Depth -- ------ Diameter __ ------- Number ___--------�- -- - Water Table Depth -----------�� --- ----------------------- ---Rock Size - ---_ 7'a ------ -------- • � Distance to nearest: Well -----�� ----------------- Foundation/40- ------- Prop. Line _ _•. _ .... a REPAIR/ADDITION(Prev. Sanitation Permit# -------- --------------------------------------------------------- Date --------------------------------- I Septic Tank (Specify Requirements) -------------------------_ ----- ----------------------------------------------- Disposal Field (Specify Requirementsi -------------------------------------------------------------------------------------- ----------------- --------------------------------------------------------=----------------------------------------- ------------------- (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 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 Compensate. laws f Calif rnia." d --- -------i:--- ----------- - -- ------ t Owner By ... , itle ---------------- -- ----------------------------------- --- -- (If o#her th Sig an owner} FOR .DEPARTMENT USE ONLY P 1 APPLICATION ACCEPTED BY -- ---------`------------ -------------------------------- DATE __ --1-- -- ---- ----- ----------------- BUILDING PERMIT ISSUED -- ------------------------ - -----DATE ------------------------------------------- ADDITIONAL COMMENTS ---------------------------- --- ------------------------------- ------------------ ---- -----------------{ _-- - ate ._--------------- ------- D--- ---- 7 ---- ---- -----------------------------------------Final Inspection `l � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H:9 1-'68 Rev. 5M