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UR C:FFICE USE: � APPLICATION FOR SANITATION PERMIT ;.. - - - - - d Permit No. "..G .k (Complete in Triplicate) a. ---- This Permit Expires S Year From Date[.SsaefJ 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: JOB ADDRESS/LOCATION -l ----° ------ ---- ,' ------- __ _ - _ _CENSUS TRACT -------_----- --- Owner's Name ---------------------- - � ....... - - ..Phone Addressil_+,� L _ , ( 4 . City � .. License # J F PhoneContractor's ` --- Installation will serve: Residence�Apartment House❑ Commercial []Trailer Court ❑ Motel ❑Other .-------------------- __._..------------- Number of living units:- -,_ Number of bedrooms ----- ----Garbage Grinder __--------__ Lot Size ..._.,4.`" Water Supply: Public System and name .-_-------------------- ----.-__.---..-------------.._------------------------------------------Private _ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam lv� Clay 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 see age pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size_ `K.._Jk'--- AT-L"___-_ Liquid Depth . .j.c?............._. Q� Capacityb - Type(�_rx^-i4)---- Material..`` -%'-:f_La- No. Compartments ... ............ (rJ i Distance to nea est: Well _--_---t?-.._.___..------._Foundation _-/0-1------------ Prop. Line ..—2 LEACHING LINE [✓] No, of Lines ----------- Length of each line.....? -.----- ...------ Total Length ._. -------- 'D' . .__'D' Box _ ___. Type Filter Material __3 1Z,-_...Depth Filter Material -.___l1_ ......__._.__.-__ ------- � �l Distance to nearest: Well _.-1D'___-__-_ Foundation .---4� Property Line ------5--- ----------- SEEPAGE PIT [ j Depth ._..- ------------ Diameter - Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth .----------------------------------------Rock Size ----------- ------------ -- Distance to nearest: Well --------------------.-------------------Foundation __-_ -------------- Prop. Line ---------._....__.._. REPAIR/ADDITION(Prev. Sanitation Permit# ---------------. ----_____ ------------- Date ---------------- -------) Septic Tank (Specify Requirements) ------ ------ - - -- ------ ---------------------------------------- ---- Disposal Field (Specify Requirements) --------------------- ....... -----------_...--..-...___ --- ---_._ ----------------------------- ------ ...................__......--------------------------------------------------------------------------------..... (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 Sore 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, 1 shall not employ any person. in such manner as to become subject to Workman's Compensation laws of California." Signed .--- - ... _- >_ --.. Owner By -------- " r . r Title a , (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .tc _____-,__________________________.-____.... DATE .7.'2- ----------------------- BUILDING _L.--7 ----- ----- - - BUILDING PERMIT ISSUED ----- -_-- --._.--._-----.__---_-._-----DATE- ------------------------------------------ ADDITIONAL COMMENTS - ------------ ------------------------------ -------------------------- ------ -- -- - -- ----------------- ---- - -------- _ - -- - ------------ ----------- ---- ----------------`------------------------- ------ _ . ---- -------- _...__..... ----------- - - ------------- --------------- --------------- --------------- -------------- - - ------------ ----- ---------------- - - --- -?. - ` - - - - - - Finallnspectionby: -/ -�----- -'- -------------------------------------- --- -- ---- ---- Date .�_yy'i: ----r f . SAN JOAQUIN LOCAL HEALTH DISTRICT " E. H. 9 1-'68 Rev. 5M