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FOR OFFICE USE: -- AOPLICATION FOR SANITATION PERMIT ____________________ _____ __.-____.__________..___- (Complete in Triplicate) Permit - This Permit Expires 1 Year From Date Issued Date Issued . 'S--` �Aepplication is hereby made to the San Joaquin Local Health District fora permit described. This application is made in co`mplianc with County Ordinance o. 549oand existing Rules construct and tand Regulations:l the work rein 4. JOB ADDRESS/LOC ION / -, -2/ T - - ----- ---------------CENSUS TRACT ----s � y- - it ------ --------- -- ---- - Owner's Name _._ - ------- ------ e --•------------------------ � ----------- - ---Phone ------------------------------------ City -------- --- ---------------------- i Address ------f-�-� -- - ----- - , Cit Y I r _______________k___..________.________-__________. Contractor's Name _..___- • - ------- --- -- -.License #C� �' _ Phone ------ --------------- Installation will serve: Residences Apartment House,0 Commercial;❑Tralier Court ;❑ k Motel ❑ Other ------------------ . Number of living units:----- Number of bedrooms � -_Garbage Grinder _-_______.__ Lot Size _ Water Supply; Public System and name '�_ - pp Y: --------------------------------------- - ----------- - L ------Private - ------------------ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ P Hard an ❑ Adobe ❑ Fill Material ------------ If yes, type -------------------------- ` {Plot plan, showing size of lot, location if system in relation to wells, buildings, etc, must be -placed on reverse side. NEW INSTALL ? INSTALLATION: (No septic tank o6seepage pit permitted if public sewer is available within 200 feet,j PACKAGE TREATMENT [ ] SEPTIC TANK;,`[- NEW ANK`- [ _ - -= = "`' Liquid Depth --- s Capacity --- ----------- t TYp9 .. _: :._Material------ No. Compartments--=---------------- . ` a; t _.Distance-te_,nearest: Well ------------ -----------------------Foundation Prop. Line------------------------ LEACHING LINE [ I 'No. of Lines- ----------- - ----- Length of each line--________ ------- - ------ Total Length k ' 'D' Box �.__.___ ype Filter Material --------------------Depth Filter Material _______-_- ' a ------------- Distance to.� nearest: Well ----._.__-_--___.:_�-_� Foundation h ' ----- -------- --------- Property Line ............ --- =- SEEPAGE PIT [ Water I - Diameter ---------- --- Number `- 1 I1 ------- -------- ------ Rock Filled Yes p � No r Table Depth!1_7!= -----Rock Size . . Distance to nearest'' Weil _.-__--__--------------- . ____-____ .Foundation .. Pro Line - ------------------ EPAIR/ADDITION(Prey. Sanitation Permit i _______________ ----------------------------- Date �---------- ------ } Septic Tank {Specify Requirements) ________________ -------------- -----------------------------------------------------= - ------------ -- � :..-- - -------------------- sal Field (Specify Requirements) �-->� t jb d ------ - ----- ------ --------- ----------- ----------------------- f i i _ :, - '- (>.-Wil'/O t } (Draw existing and required addition on reverse side) ' 1 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 an as to become subject to Workman's Compensation laws of California." P y y person in such manner, Signed ------ ----- ' �) i 1 ----- -- Owner By _. - __.- -- - 1 '"'K=ew i Title (If other than owner) --- -- ----------------------------------- FOR DEPAR MENT USE ONLY APPLICATION ACCEPT BY --------------- .' --.BJ�D GPERMIT 5SUED ) - 1 1 - DATE --- J--------- - •----- ----`--------- i� i ADDITIONAL COMMENTS ------------------ -------DATE ----------- --------------------- - ---------- ---------------- ------------- ----------------- t ------------------ ------------- ------------------ --- ----=-------------------------------------/----------------�-T-�-/- --------------------------------------------------------------- -----------Final Inspection by: _- - - --- ------------------------ ----------- ---- - - ------ -------- Date / ----------------------SAN ' •------ - . JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.