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FOR OFFICE USE: ��! APPLICATION FOR SANITATION PERMIT � Permit No, _ � �-.-�� (Complete in Triplicate Date Issued _�-"�—..��.-� ...------. ---------------- This Permit Expires 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: �LG� l' CENSUS TRACT •---- JOB ADDRESS/ LOCATION .-.I ---- -----� Owner's Name L J �/ _Q'v.......... ...... ........ Phone Address_1.917_3_ _ ._ .- - ;?'t.e:'_ _.... � --- --- city �' f � --------•------- ...... � r y b.s"f �} -----.License #- cl�x•I Phone Contractor's Name . -6111 _ n— �aJ�`---- Installation will serve: Residence Apartment House ❑ Commercial ❑Trailet Court ❑ Motel ❑ Other ..__. �� T`� ... Number of living units....__._.. Number of bedrooms ---- ... Garbage Grinder _...___-__. Lot Size _ .. __._/Z�G_ ----"�--------•- Water Supply: Public System and name ................. Private f,F' Character of soil to a depth of 3 feet: Sand p Silt[] Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam -0 Hardpan ❑ Adobe ❑ 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 pudic sewer is available within 200 feet,) Size . 3---- �...�.--� ------ q P - PACKAGE TREATMENT [ 1 SEPTIC TANK (] 'T 2t� . �i Type -__.__-_--•--_-__-- Material C�or�No. Compartments---• - •- Capaaty ;.. - - --- --• YP Distance to nearest: Well -------- ........... ......... _...... Foundation --- -------- .......... Prop. Line __.... ._._:......____. Len th'of ach line... ...L_�-- _... Total Length ------._s's-Q--•-------- LEACHING LINE (] No. of Lines .- 9 D' Box . Type Filter -Material _,I�-C'e_ _Depth Filter Material -..1------_--_----�---•-••-•- � .... Foundation-1.�..------- -Property Line _....�.---.......--- j Distance to nearest: Well .-_-..5�'- Rock Filled Yes ❑ Number NO ------ ----- -- - Diameter ------------------ --- SEEPAGE PIT [ 1 Depth --�----- ------- --.___-.__Rock Size Water Table Depth --. ..................... 1 Distance to nearest: Well ---- ----- ------------ -------------- Foundation ..------••-- Prop. Line REPAIR/ADDITION (Prev. Sanitation Permit # ....----••--------- ----- ----- - Date l `Septic Tank (Specify Requirements) = 1 -------------------------------------------- Disposal Field (Specify Requirements) f •--- •----•-•----------------------•----- ---------------------••-- ------••---•,-----•------------------------------- ................................................. {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 i County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: j "1 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 Workman's Compensation laws of California." Signed_ - --- --_ .-- -_ Owner - .Title .--- .....-- --- ------------------ ' (I other than owner) FOR DEPART T O LY .................... DATE . ......... APPLICATION ACCEPTED BY ----------------------------------------------- BUILDING PERMIT ISSUED ._......;--•_..___..--•- .. - --------•-•-.. DAT ...._._..-•.............. ADDITIONAL COMMENTS ---• =........................................ •-•-.....•..... -.... i-------------•---••---.-.----••---••---•-•---..----•-----•-•---------•---------------------- ------•- ••--•----- •------------•-•------ •-- •--•-•-- ---•---•-._.......................••..................................... -•-- _ ---•------ --•--....------•. •-- -•--•- {� - ---- Date ..-- . ..... Final Inspection by: ---------------- SAN JO QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M