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FOR OFFICE USE APPLICATION FOR SANITATION Pr-MIT 7 q ..............-- ---------�p------op----- Permit No. � (Complete in Triplicate) Date Issued - -- ------- This Permit Expires 1 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 compli nce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..POl'----�f7-__- -� --- ---- /QCT -- CENSUS TRACT --.__..-.__--.._-- -- Owner's Name _ ft>_ -- �F .. . . --- ------ -- Phone .. Address - _�P�_6.. _ �� --- Contractor's Name _..__-_ ' - - - u/'� . �., .License #s: -'527-3Phone _ la- -« - � Installation will serve: R idenceKl Apartment House❑ Commercial []Trailer Court 0Mot��,eOther . ------ --------- ---------- Number of living units:_.__ Number of bedrooms -----Garbage Grinder ___.__ Lot Size _- .20- Water Supply: Public System and name - __ ___ -__ ---------------------------------------Privat�7 Character of soil to a depth of 3 feet: Sand 0 Silt❑ ClaKillaterial Peat F1 Sandy Loam F1 Clay Loam ❑ I \ Hardpan E] Ad--- ❑ ___.-__ 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 jREATMENT [ ] SEPTIC TANK[ ] Size------ ---------------..__ ----- Liquid Depth _.-- -.___.--.----- 6 Capacity ____-- Type __------ ....... Material....----... -.. No. Compartments -. __--------------- O Distance to nearest: Well .... ___-....__--------- ------Foundation -----_--------------- Prop. Line .--.-_-_-..---_..-- 6 LEACHING LINE _ [ ] No. of Lines ___.1......... ..... Length of egch line____.. .____ Tota[ Length t_.....-----.. e ei 'D' Box .- Type Filter Material - -.'y--Depth Filter Material -_ j-------_---.-----.-�---- ff -� Distance to nearest: Well ._/l>ll..fi----- Foundation ..._/Cf..-__-_-- Property Line ---_%.S7 SEEPAGE PIT [ ] Depth ._��-_ Diameter Number ___ -....__..... _, Rock Filled Yes jj�- No 1❑ 9' Water Table Depth __-. r -Rock Size --:2. � r, Distance to nearest: Well ------.___-.----------------------...Foundation _-_-.. ----------- Prop. Line __--_..--_......-- REPAIR/ADDITION(Prev. Sanitation Permit# ..... .........._____-------______- Date ----------------------------------I Septic Tank (Specify Requirements) ----------------------------------------------...---------...--------- - ----------- / ---- Dispo I 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: "1 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 becom ct to W!owner) an's omp tion laws of California." Signed - _ - Owner By - - CSitle (If other than FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ... - - ----------------- DATE BUILDING PERMIT ISSUED ..____-___-.- - ---------- ADDITIONAL COMMENTS .-------------- -------------------------------------------------------- FiFinal Insp-...---------- - - - --- ---- - - - - - - - -- nal nspection by: -- - ---------------------------------------------------------Date -.'-. � --\.LS. ----1 -....-- SAN JOAQUIN LOCAL HEALTH DISTRICT CID E. H. 9 1-'68 Rev. 5M