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FOR OFFICE USE: ! APPLICATION a Y� APPLICATION FOR SANITATION PERMIT /__ e ,11 Permit No. _-_------ -- (Complete in Triplicate) IM Date Issued "-Tl--9-��-- This Permit Expires I Year�From Date)sawed - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiorir is made in compliance with County Ordnance Na. 549 and existing Rules and Regulations: JOB ADDRESS/LO ONI� _------CENSUS TRACT __________________________ .��.�-_�-_. ---- -------- Owner's Name - ' CltY ---------------------- ------------------------ Address ` Address Y .� -• J ' +------- --- --------- ---------- Contractor's Name . h License #a7_ /. , Phone f Installation will serve: �i Residence ❑ Apartment House❑ ommercial ❑Trailer Court i0 Motel�'bther 4) Number of living units:__ ------- Number of bedrooms -------- Garbage Grinder Lot Size L �"�' " ---------•----- System and name i. - - = Private ❑ 1 e Water Supply. Public S stee Character of soil to a depth of 3 feet: Sand'❑ Silt{] Clay Llj Peat❑ Sandy Loam ❑ Clay Loam :❑ Adobe Fill II ❑ Material if yes, type -------------------- Hardpan E I� (Plot plan, showing sizef'lot," location of system in relation to�wells, buildings, etc. must be placed on reverse side.) I f public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or see page it permitted rr 11 p p9iP� P PACKAGE TREATMENT [ i] SEPTIC TANK I Srze__yl -- -x � " Liquid Depth ___-' --------------- 6 � _ k �/� Na. Compartments --_- ----- Capacity/p�OC _______ TYPe _ - -- Mate !TC --- Distance to nearest: Well A , ;M r -- ----------Foundation --�Q--- -:Prop. Line -`�--- -----•----- _- ___ Len th of elach line_ 40- ---_.----.__ Total Length4 - ----- p� lo. of Lines -- ------- J ./ 4 LEACHING LINE r1 p ... ,.. D' Box -----___°-_`Type Filter Material S'-�OG�'---Depth Filter Material ____��-------------�- Property Line -- ---- ---------•-- ` Distance to nearest: Well -�r Foundation .__ ----------- P tY ��, Rock::Filled Yes No i❑ IIS Number ,� .� SEEPAGE PIT Depth '---- Diameter ! Water Table �De th ____-_-��-------- i p ` -- Rock Size - ---.�n---- r E lilt ' . Distance to nearest: Well _ __ _ _ --------------•- Foundation "- 4 ----- Prop. Line ____ _____ ___ ` ------ -� Date --------------------------------- 1 REPAIR/AbbIT10N(Prev. Sanitation Permit# _--.-----`---------- --- � - Septic Tank (Specify Requirements) ------------ lot'f --------------- - Disposal Field (Specify Requirements) 4 ----------------------------- t ---------------------------- ------15---------- ---- ----------------------------- ------------- ---------- ------------------------------ ------ ------------- ------------------------- and required a --------------------------- ---------------------------------- g 'ddition on reverse side) (Draw existing q [ I hereby certify that I h�ve prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of thle San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: I f "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 bec a subject to or an's Compere tion laws of Califnia." w Signed ---- ------ ` NCZ ----�'� -----------}�-- Owner '-)- 1p �I 1. Title --------- ----------- BY -------------- - ------ --- (if other thlan owner) 11 D RTMENT USE ONLY q APPLICATION ACCEPTED BY �� DATE -- �I'� ----------- ------ --- -- -- -- - - - - -------- BUILDING PERMIT ISSUED ----------- - DATE --- - ----- - ---- -- -- --------- ADDITIONAL COM?__ TS_. M----------------------------- `=------------ 6- 7( / 1 )-----------------------------------' ----------------"---------.---- r ----- ---- ----- -- ------ - - -------------------------------------- ------------------------------- ----- - ----=------- IM J �• --------------- ----- - Date � � .1-- : - - Final Inspection by- ---------II ------------------ [ ------- --------------------------- :-_ ,,, , ,e•" SA JOAQUIN LOCAL HEALTH DISTRICT ' � I E. H. 9 1-'68 v. 5,M