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FOR OFFICE USE. - � `��7 A(w APPLICATION FOR_;SANITATION PERMIT -----------------------------CI ._.-___.___-._ . ` (Complete Permit No: -.- "_a�_- .• omplete in Triplicate) - 4 _______________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit-t6-construct and install the work herein, described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION / . .--- --- D-- - 4- --------------------- CENSUS TRACT Owner's Name ---, 1" (fiI'=:__r: -=----- ---------------------------------------Phone- ` Address /Own .. ulJrs? Fez) City,.F"T Contractor's Name -- ov- ow —--------------------------•----------License + _._ Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court J] Motel ❑Other - Number of living units:__/--____ Number of bedrooms _X-------Garbage Grinder 1_T 4f_._ Lot Size,��_-_______ Water Supply: Public System and 'name __-� �G/ _ ?l� .__ ' -��/.� t~ ___"""-"Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ " Hardpan ❑ AdobeA Fill Material ------------ If yes, type ______________________--____ (Plot plan, showing size of lot, Ideation of system in relation to wells, buildings, etc. must be placed on reverse side.) �1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewers available within 200 feet,) \ PACKAGE TREATMENT [ 1 SEPTICTANKY� Size X_—+ _______________`�_._-.Liquid Depth: __.. _ __. Capacity / � Type, _ -" Materia�%X1V-J�No.f Compartments �-. W Distance to nearest: Well -------______ '-------------------Foundation ---.f�___--�-'_--- Prop. Line _a.:?------______-.-.- LEACHING LINE [ ) No. of Lits --- ------------ Length of each line--------'-- --------- Total Length "-----_._ 'D' Box _ T _f _""_- '-__. Type Filter Material ____'-�___ _ -____.Depth Filter Material ___::y--__ » � Distance to nearest: Well --------------d_________-- Founa"ation _r.., Property Line -----------..........._ F �' SEEPAGE PIT [ ] Depth /_-_ ______ Diameter ---------------- Rock Filled YesX No iCj p �. - -�/��-- Number -----_--_.-- Water Table Depth - Rock Size _f` s L Distance tol nearest: Well ------------------------ ---------------Foundation '47---------- Prop. Line ".c ________.._.. REPAIR/ADDITION(Prev. Sanitation Permit# --------------------'------------------------ Date ------------------ Septic -------.--------Septic Tank (Specify Requirements) -------------------------- f/. - - Disposal Field (Specify Requirements) P -----"-��`L/S�� ------I; � _ _. -- ------------------ +r -------------------------------------------- -------- ------------------- r I s --------- ----------- ----------- P (Draw existing and required addition on reverse side) 3 '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, old Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- rl"�l d agents`signature certifies the following: 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 subject to Workman'51 Compensation laws of California." 1. Signed --- ------------------ w it O ner__. . --------- --------------- - -- 4 Ity -.-:------------------------ y (if of tan owner) Title � 9 `- r,` FO ARTMENT USE ONLY t APPLICATION ACCEPTED BY. DATE BUILDING PERMIT ISSUED _-- -- ---- "-- - TE ------------------- ADDITIONAL COMMENTS _ -- _ r �c e- ---� l !Q —I G(,� -_.�Z l------- `------- ------------------ { ----- ------------ --------------------------------- -------------------- - ----- — — - - - --- -------------- Final Inspection -._Date __ ..... --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRIC E. H. 9 1-'68 Rev. 5M ; 4 :i