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FOR OFFICE USE: I. APPLICATION FOR SANITATION PERMIT /' -----------------------------------•---------------- (Complete in Triplicate) Permit No. 46- :n_&2,__ ----------------------------------------- ----------- -------------- ---- ------- This Permit Expires 1 Year From Date Issued Date Issued l�'_� ':�. 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 w.itf�County Ordinance_No.,549 and existing Rules and Regulations: SK, 1CENSUS TRACT - --JOB ADDR_SS/LOCATyON .------ '-- --. �+------- ____ j_---- �t" Owner's Name _a_.m r ---Pb-ne -----—---------------------------- Cit --------------------- ----•-. Address Y ---------- Contractor's Name _.-r- -.-._ �1 -_-_ _ _ _ r__ - - �k-------- --,License # -UF3 Phon _-------------------- t Installation will serve. Residence partment House ❑ Commercial ❑Trailer Court ;❑ I Motel ❑ Other ----- -----------------------------------7_24A Number of living units--------I__._ Number of bedrooms _'__Garbage Grinder ------------ Lot Size _c_s__________________ Water Supply. Public System and name --------------------------------- -------------------------------------------------------------- --------Private L�1` Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay [:] Peat❑ Sandy I Clay Loam "❑ - -•-----�— ---- 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 see age pit permitted if ublic sewer`ailable within 200 feet,) f PACKAGE TREATMENT SEPTIC TANK [ Sizerf�-' - _______._.-__.___-__ Liquid Depth ___q___________________ { , G - Material 'M � __ _ No. Compartments +_._..__.--__ Capacity�� ----- - + TYp P Distance to nearest: Well ------------4'€t--- _____________Foundation -- /_u__r_______ Prop. Line __,°S______________ LEACHING LINE [!] No. of Lines ___ -------------- Length of each nline----- t' ------------- Total Length ,_-_ _____-_- 'D' Box _-- Type Filter Material ------ `! =---Depth Filter Material -----III__._.__-------------------- --- - J. / Distance t nearest: Well ------ITO__r._________ Foundation ____ _!a__..____.___ Property Line _---.'�_______________ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number --- ---------------------- Rock Filled Yes ❑ No (03 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well .----------------------------------------Foundation -------------------- Prop. Line -----_------------_ -- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------- ---- Date ---------------------------------- ;_f f Septic Tank (Specify Requirements) -.------ --- ---------- ----------------------- ---------------•---------- -------•----- --.•-- -------------------- Disposal Field (Specify Requirements) '"--------------------- ---•--•----------------------------------------------------------------------------------------- ----------- Y ________________________________________________________________ _ _._____________________.______________------_____-_______________________.____._ _ y 4 _________________________________ -----.----------------------------------------------------------------------------------------------------------------------------------- (Draw exisiting 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'Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following- "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become sub' to Workman's Com ensation laws of California." Signed ----- --- ----= '--------------- Owner' i BY --- -------------- A ------------- Title --- ------------------------- - (I other than owner),-.oe r. OR DEPARTMENT JJSE ONLY APPLICATION ACCEPTED 8Y - BUILDING PERMIT ISSUED -------------------------------------------- ----DATE --------------------------------------- -------------------------------------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------------=--------------------------- ---------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------'------------------- ------------------ --- -------- --------------- -------------------------------- -------------------------------------- ---------------------------------------------------------- -------------------------------- - - -------- ---- ------------------------------------------------------------------------ -------- t .,. j Final Inspection by -- ----------------------------- Date � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M