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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate) Permit No. a Q -- -------------- Date Issued . �� 31=_23 __________________.______._-----._.__._________ This Permit Expires l 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: A lP e /: �- r 1 .r =e = ----------- ------ CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION �� ..�,` ---- --�-_----- -- - Owner's Name --- � '.2 - Phone? y --t-Z--- XZ ' = Address ----------------- �_ s�---------- 4, te_.,. Cit r _ _ Contractor's Name `{...... �` ff .. .c License # _ Phone Installation will serve: Residence 1 Apartment House f7 Commercial❑Trailer Court '' Motel`"❑ Other Number of living units_____________ Number of bedrooms _=_________Garbage Grinder ----------._ Lot Size --------.-----------------:- Water Supply: Public System and name ----------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ .._ _r__ ... �x. Hardpan ❑ Adobe,E] Fill Material ------------ If yes, type ----------__________________ t (Plot plan, showing size of lot, location of system Sin relation to wells, buildings, etc. must be placed on reverse side.) LJ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-_----------------------------------- - Liquid Depth _------------i------------ I CapacitY .......--- --- ,Y;p � - - ----�£ � . � No. Compartments ------------_-- F :.... Distance to nearest:- Welle f-_-----r- - Material Foundation _ 1 - - - --- Prop. Line - •---•-------------- LEACHING ------------ �. --------- - LEACHING LINE ( ] No. of Lines ---- ----------------- Length of each .line--------.___;:______.______ Total Length ------.------.-------------- D' Box -------- Type Filte f Mate�iai '--'+� -------- Depth Filter; Material Distance to nearest: Well _ ----------- ' Foundation"____..___ ___ ----- Property Line ________________________ t SEEPAGE PIT Depth _ Diameter Number __ ._ _ Rock-filled Yes No 0 Water Table Depth ------- --.---.Rock Size " ' - +r �t Distance to nearest: Well -----------------------`-- '----- Foundation,.__ - Prop. Line ---------------------- ____Found ---------- Date -- -� .`- • REPAIR/ADDITION(Prev. Sanitation Permit# -------•.------------------------- -----:------_____4:=----____-) `Septic Tank (Specify Requirements) )'`'----------------- t--.--'-------......----- '----=----------------------------------------- ------ Disposal Field (Specify Requirements) -------- '-=----------------------------------------------- ------ i. ----------- ---------------- ..--- .-....-- -. --- 1 4 ------------------------------------------------ - - - - - - - {Draw existing and required add ition_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 beco e,subject to Workman's Compensation laws of California." Signed __ ---- = - Owner - BY ------------ Title -- ---------------------------- - ---------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ - -- -------------------- DATE ------------------ BUILDING PERMIT ISSUED . DATE --_.._- A --------- w ff ADDITIONAL COMMENTS --------- o, /__ __ - 4-[ i --------------------------------- AlL --� qr v`------------------------ --------------------- -{moi -` .. _------ -------------------------- �:---- - --_---- �'7 - -�---------------- -------- Final Inspection b --------- - - ------------- -- -------- -------------------------------------------------------- -Date _.. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M