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-"FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' P (Complete in Triplicate) Permit No: 0"� ---d ------------------------------------------------------ This Permit Expires ] Year From Date Issued Date Issued -----4�`-- a 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 ADDRESSAOCATION ---- � j� ,Gj}/, CENSUS TRACT Owner's Name ---- �_Q -------------------------- ------ -------••- ------------------Phone --------- Address _--: +1 -------------------- ----------------------------- City - -----------------.---- Contractor'4 Name .- � `5 t --_.License ? Phone Installation wil.1 serve. Residence W]Apartment House�❑ Commercial❑Trailer Court ' M [ otel ❑Other _ / ------------------------------------------- - Number of living units------1_ '"Number of bedrooms __z-----Garbage Grinder A10--- Lot Size -Water Supply:Supply: Public System and name ------------------------------------ ________________Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam.0 Hardpan E] Adobe 'X 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,) PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Sizes___________________---------------------------------------------- Liquid Depth -------------------- ..__. ND Capacity - '---------------- Type ------------=------ Material------------ --------- No. Compartments ----- .... \ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------•------_---- LEACHING LINE [ j No. of Lines ------------------------ Length of each line---------------------------- Total Length 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ___------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line SEEPAGE PIT [ ] Depth --- ------ Diameter -----------•---- Number ---------------------------- Rock Filled Yes ❑• No i❑ 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) __- - O-X-_-- _ Q � f flJ/ - -fix • -_ l 7`. { - --------------------------------------- - -------------- -------------- (Draw existing and required addition on reverse side) r I hereby certify that I have prepared this application and that the work will be done in accordance with San J ag41n County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- i 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 Wor an's pens hon laws of California." Signed ------------------------ , ---�-- ------�- -�- �---.------- ----- Owner 1 ----------- By --- -- --------------------------------------------------- ti= -------------------------------------- Title ------------------------------- ----------- (If other than owner) ; OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ _ - �- -_- __ _--- ------------------------------------- --------------------------- DATE _.-------_ : BUILDING PERMIT ISSUED ` --= ------- ----DATE ----------------------------------------- ---------- ------------------------ COMMENTS .- ---- - __-_-• - _ [f-- ---- -- - - ---- ---------- - --- ----- -------- -- __ -------- - 5----------� :_�=:a�.------- -- -------------- ------------------ ------ ---------------------------------- ----- - Final Inspection by: __ ------------------------------------------------------------------------------------ ------ ---------------------------------------- --------------- -Date _ �- SAN JOAQUIN LOCAL HEALTH DISTRICT E N. 9 1-'68 Rev. 5M. s