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Address . <br />Contractor's Name .,.. ..... <br />FOR OFFICE USE: <br />PUCATION FOR SANITATION PERMIT <br />tComplete in Triplicate) <br />This Permit Expires I Year From Date Issued <br />Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein <br />described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />C' <br />/ <br />/ CENSUS TRACT JOB ADDRESS/LOCA; N t. <br />. Phone <br />. . <br />Owner's Name .01 <br />frAg' <br />Installation will serve: Residence, Apartment House 0 Commercial CTrailer Court El <br />Motel C Other <br />Number of living units, Number of bedrooms Garbage Grinder Lot Size <br />Water Supply: Public System and name Private <br />Character of soil to a depth of 3 feet: Sand C t 0 Clay 0 'Peat 0 Sandy Loom El Clay Loom C <br />Hardpan Adobe 0 Fill Mdterial, If yes, type <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) "4\ <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) . <br />PACKAGE TREATMENT [ :i SEPTIC TANK Size 4 ,r5 Liquid Depth......... .. .. <br />Distance to nearest: Well <br />Capacity 1 2-6)6 Type o. Material1-ft-4.4---' .-.-41"-1--A-d1P_ N Comportments <br />.. <br /> <br />co _Foundation ' <br />LEACHING LINE Ncfr No. of Lines I ' -Length of 'each .line C)e" Total Length / 0 0 / <br />'D' Box ... •• Type Filter !Material f? .. __Depth Filter Material 1 / '" <br />. ..... .. <br />(Draw existing and required addition on reverse side) <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br />sed agents signature certifies the following: <br />"I certify thst._in the performance of the work for which thls .permit h issued, I shall not employ_any person in such manner <br />as to become subject to Workman's Compensation laws of California." <br />Permit No. —7 1- g 3 <br />Date Issued <br />City <br />- License # <br />r ! <br />../// Distance t .0 o nearest: Well ..i.5 / J Foundation O / Property Line --.1 <br />SEEPAGE PIT {j Depth ?-,-.5" I Diameter "3 3 ' Number r'S..) , Rock Filled Yes No 0 <br />Water Table Depth Y 1) / . Rock Size igi '5( 3 ' - <br />Distance to nearest: Well 1 /01:, r - - FouricicTtiOn 7./.0 . r • ' Prop7.- Line ---..5r:-• <br />REPAIR/ADDITION (Prey, Sanitation Permit # .1 ' Date ) <br />Septic Tank (Specify Requirements) . .-, .- <br />Disposal Field (Specify Requirements) <br />Prop. Line . <br />Signed <br />By „ <br /> <br />.... ,Owner <br />Titre aelj <br />(If other than owner) <br />.2) <br /> FOR DEPARTMENT USE ONLY "Wws. <br />APPLICATION ACCEPTED BY ."....04---Y14,1,40'41 DATE 9 .,-./ ... - <br />ADDITIONAL COMMENTS. <br />........ DATE BUILDING PERMIT ISSUED <br />y .......... • <br />Final Inspection by: <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />....... • - • • <br />E. H. 9 1-'68 Rev, 5M