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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.'v..-_Y��..(o ------ ------....__--------- This Permif 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 compliance with County Ordinance No. 549 and exist' g,Rules and Regulations: r JOB ADDRESS/LOCATI _ - � NSUS TRACT ____._---.------_--- Owner's Name .� �° y�/ �i-r'-`------------------ ----------_------------------/°� �----- Phone - - ---- - - ---- --- - - d b r ems - Contractor's Name ...__ _ ----__-.-_-_____.License #Za0 _ _ Phon Installation will serve: ResidenceA Apartment House❑ Commercial❑Trailer Court i❑ r Motel ❑Other -- --rte------------------- ...............-- ` Number of living units:_-/--_. Number of bedrooms .3------Garbage Grinder f/ Lot Size 14-a-e�e�l -------- Water --- ---Water Supply: Public System and name ----------------------------------------------------------�-----------------------------------------Private A Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay Peat❑ Sandy LoamClay Loam ❑ Hardpan ❑ Adobe ❑ 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,) J f PACKAGE TREATMENT SEPTIC TANK ._-----_.- Liquid Depth /_.--_____-.--. C! Capacity,l0,4 _ Type-�2�'�aterial_�.t711�1--�-- No. Compartments -----� -.---.--.- i Distance to nearest: Well .� �________-____-__Foundation -/.-.___. Prop. Line /Gr?1 --_--_ `.. " .LEACHING LINE No, of Lines _--,r--------------- Length of eacch•li_ne5 f��_ ------ Total Length � .'.....--_. 4 ! AV D' Box j__t�i19Type Filter Materialj.,G/ 0,40. Depth Filter Material, ..__-________________----- - Distan a Todnearest: Well - _______- Fo}rndation a�..'- ________ Property Line ...__.-.---�c k SEEPAGE PIT Depth .� _- Diameter .-.-___- Number ;?�------- Rock Filled Yes j ; No ❑ Water Table Depth --------_. _-------......Rock Size ---------- _----- Distance -_Distance to nearest: Well -____l Q--------------------Foundation ---- Prop. Line -_30-------_- REPAIR/ADDITION(Prev. Sanitation Permit# ----------- If. ------------------ Dote ____-_-----_-_--.-_---_ 1-------) Septic Tank (Specify Requirements) ------------------------"--------I--------------------------------- ----------------L_ __ - Disposal Field (Specify Requirements) ------------------------------ -------------------------------------------------------- -------- ..... (Draw existing and tequired addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accord nce wit,cah San Joaquin .� County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Disfiicf. Home stviner or licen- sed agents signature certifies the following- "I certify that in the performance of The work for which this permit is issued,A shall not employ any person in such manner as to become subject to Workman's Compe tion laws of California." Signed -- -------------- - ---- --- -------------------------- Owner 1, By - - - -- - -------- ------ ---- Title (If r than own r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------- ------ ---------------------------------------•- -------------- DATE --- ----------------- BUILDING PERMIT ISSUED .--------------------------------- ------- ---------------------------- ------V -----------._DATE ADDITIONALCOMMENTS ------ ------------- ------------------------------------------------ - - - ---------------- --------------- ---- --_---------------- ---------------------------- ------ ------------------------------------------------------------------------------------------ - ----- -------- - - -------- - --- -- ---------------------------------- --------------------------- -------------- S ---------------- -- ----- r .-..-..____I_-- ems _ __- -________ .�.___ --_-.--_----__._ _._ _ -.n_.__.. _ - -___- _ -. - -- -;-- ----------------Date �fs��Q --------...--- ;� -- - - - --- - - Final Inspection Dom. -' - - - - -------------------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M