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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r Q' (Complete in Triplicate) Permit No. ------------------------------------- - Date Issued _x'_ �_---------- 1?0----- ---- --,?0---------- This Permit Expires 1 Year From Date Issued D Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with 9runty Ordinance No. 549 and existing Rules and Regulations: l' % - -- -------._CENSUS TRACT --------- ------ ------- - JOB ADDRESS/LOC I N .____4L��-- f- -- - - - -- --- Owner's Name ---- -- -------Phone Address ---------- --------- -------------------- City -------•-------------------------------- Contractor's Name -- tL �.Er /P 11 "r' Licens ------------- - Phone �"" f� Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------- ----------------- Number of living units:---- Number of bedrooms _Z_ -_-Garbage Grin er _ ________ Lot Size .___--_________________________________ t Water Supply: Public System and name -------! r!!C!*-----------------------------------Private El Character of soil to a depth of 3 feet: Sand'❑ Silt Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam .E] Hardpan ❑ Adobe'91 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.j NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK I ] Size------------------------------------------------ Liquid Depth _._________________.-- Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------ --------------- a Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -----.---------.------ .� LEACHING LINE ] No. of Lines ------------------------ Length of each line-------------------------__ Total Length -----------_.......... 'D' Box ------------ Type Filter Material --------------------Depth Filter iMaterial -------------------------------- ........-_._ Distance to. nearest: Well ------------------------------------- Foundation ------------------------ Property Cine ------------------•--•-- 5EE?AGE PITF_�r'[.]. Depth -------------------- Diameter ---------------- Number ---------------- _--.------_ Rock Filled Yes ❑ No 0 ` Water Table Depth ___ ______Rock Size _._ " --------------------------------------- ----------------------------- -�� Distance to nearest: Well ----------------------------------------Foundatjaon -------- Prop. Line -------•-------------- REPAI{I�fADDITION[Prev.�Sanitation Permit�# ---------------------- - ------------.---,Date. --------- ------------ _--�) Septic Tank (Specify'Requirements)______________ --- ------ sposal field (Specify equirements) Q_ __l �.�__sae ' = ,:--------- - -----c-r------- - ------------------ -------------- - -- -- ------ --------- ------------------------- -----------------_________________________________________________________________ ------------------------------------ ---------------------------------------------__._______________.---_--_-_____--__________- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and IFules and Regulations of the San Joaquin Local Hea_Ith District. Home owner or licen- sed agents signature certifies the folloviing: J "I certify that in the performance of the work for which this permit is issued,'l shall not employ any person in such manner as to be subject t an Work 'Igmpens laws of IC ifornia.Signed r com By ----------- - (If other than owner) ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ✓ f `=----- ---------------------------------------------------------------- DATE - = '- ; BUILDING PERMIT ISSUED -- ;- -------- ---------- TE -- -- - ----- ------ ' fi * - -------y ADDITIONAL COMMENTS _ ,IP ___ � - •19 � -- ---- ---�----------- -_ � '- -- -- --- - ----------------------------------- C!J c . ---- - �- '" ------------------------------------- ? c � __ - -- - - ' ------- --- - -- Final Inspection by: ----------- ---------------------------------- ------ ------------=------ -----------Date .__-�A SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.