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r JOR OFFICE USE: `,.'"',r,--- �." APPLICATION FOR SANITATION PERMIT e -.. --Permit No.— .,_/d: ------- = (Complete in Triplicate) -' Date Issued This Permit Expires res 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 comp lance with County Ordinance No. 549 and existing Rules and Regulations: CATION --- - - - ------- ----------------CENSUS TRACT ------------------- ------ JOB 1ADDRESS/LO � �/ i Owner'sName - one -- --- - - --------- -- - -- --------- I r r _ Addresse ----` City - �.. », License # 67117= Phone,y '�s$ j Contractor's Name p� - , . nstallation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ F Motel ❑ Other, ' r / Number of living units:---- Number of bedrooms'- �''_�-_Garbage Grinder ------------ Lot Size 37 - ? I Water Supply: Public System and name ---t_0 ` t'`�.. �----- -------------------------------------- ------- -Private I ----------------- Character of soil to a depth of 3 feet: Sand'Q Silt❑ Clay ❑ Peat❑ Sandy Loam -Q Clay Loam.❑ , Hardpan ❑ Adobe), Fill Material ------------ If yes, type ---------------------------- I A K (Plot plan, showing size of lot, location of systems in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) RACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size--------------------------------- Liquid Depth ; ' Ca acs T e Material ------ No. Compartments ---.-- -------- --------------------- ' � p tYYP , Distance to nearest: Well .� --- - ---------•------------Foundation --------------------- Prop. Line ------------------- LEACHING LINE A No. of Lines --------1------------- Length of each line--------W ---- ------ Total Length ,----__................... 11 'D' Box --- Type Filter Material - I.—- Filter Material - __ -------------------!_....... YP Distance to nearest: Well -----0__9 Qf--- -- - Foundation ----___� _-.-----___ Property Line ------------- ....D i / w t SEEPAGE PIT �Q Depth ----4 ------ Diamefier< - , ;-.---- Number -------------�.-------.-- Rock Filled Yes [ o t R °7��---- Rock Size r Water Table Depth ----------- ----------• -= Distance to nearest:.Well ----__�- s y ) �� ---- — --•---Foundation ----/A---------- Prop. Line --------` -------- - REPAIR/ADDITION[Prev. Sanitation Perrtirt�# -------------- ----------- Date ----------------------------------) Septic Tank {Specify Requirements) ------------------------- 11-------------- Di�posal Field (Specify Reeq-uireements)- --------------------------- ------------------------------------------------ --------------------------------------------------------- --------------------------------------------------------- 1 t k -�--- ----.�' --------------- ---------------------------------- ------------------------ (Draw existing and required addition on reverse side) I hereby certify thatil 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 tire. San Joaquin Local Health District. Iianre owner or iicen- k sed agents signature certifies the following: -"I certify t1ral in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become-subject to Workman's Compensation laws of California." Signed -.--- ------ Owner 8Y �l� �"'"�'�------------ -- - Title `�0 " li.1G ---------- ------------ r # {If oth�f than owner) 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -- - --- DATE ----��-- 1 - ---------- --------- ------------------------------------------------------------------------------- - BUILDING PERMIT ISSUED --- ------ ---------------- --------------------- - ------------- DATE ' ADDITIONAL COMMENTS --- - -- ----------------------------------------- ------------- --- E ------------------------------------ --------- -------------------- -------- k -------------'----------------------------------------------------------------------------- ' i ------- ----------------------- Final Inspection.by: -�_ ------- -SAN - -—SAN JOAQUIN. LOCAL HEALTH, DISTRICT_:' : _ E. H. 9 1-'68 Rev. 5M _ ��'