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FOR OFFICE USE: APPLICAMON FOR SANITATION PERMIT ----------------- ------------------- -.. ^' Permit No. -.7#. . (Complete in Triplicate) This Permit Expires 1 Year From Date Issued 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: -0 10 _CENSUS TRACT .---_--- `_ _-_ JOB ADDRESS/LO N ----� `� --------- --- ---------- ------- =----------- - {�------- Owner's Name Phone -------------- ` �� +� -Cit----- Address -- ---- -- :, --------•- -------- ----- --------- ------ - Y ------------------------------------------.--------- __ ---- ----License # f .- Contractor's Name -----____-- c�*-.eJ - / -- _?�- Phone ------------------------------ Installation will serve: Residence Apartment ouse'❑ Commercial ;❑Trailer Court ':E]':E] Motel ❑ Other Number of living units------------- Number of bedrooms ------------Garbage Grin er ----------- Lot Size -----------------------------------moi --._- Water Supply: Public System and name ----------- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt Cla ❑ Peat❑ Sandy Loam ❑ Clay Loam.❑ Hardpan ❑ Adobe eFill Material ------------ If yes,type ----------------------------- W, (Plot plan, showing size of lot, location of system in relation to well's,buildings, etc. must be placed on reverse side.) U� NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is a vailable within 200 feet,) �. PACKAGE TREATMENT [ ] SEPTIC TANK [ t Siie- --- '- -- `-- ------------------- Liquid Depth - ---__--• --- -_-- O goo Capacity --------- ---- T ----- Yp e - t------------ Material--------- No. Compartments -------------� - Distance to nearest:. Well _------. -�- ` __:�`__-.Foundation -----J0___--- Prop. Line ___s_._' .._--_ LEACHING LINE [�No. of Lines _---__ _______________ Length of each ;line----.----V0_--- -------- Total Length -.)-- -G. r� 'D' Box ___"------ Type Filter Material ------ __-Depth Filter Material ------- - -- --------- ------------- �� _ Foundation U-f--_---__- Property Line.,--_- e Distance to nearest: Well ______------------- -- -__ __ - p SEEPAGE PIT , [Pr" Depth --c;5iV---- Diameter 4�>_,ZP------- Number ---------- ff_ _"Roc Filled Yes No i❑ Water Table Depth ---- ---------��----------------- -------Rock Size ! -------------------------- *- Distance to nearest: Well ---------------- --------------I---____.Foundation ---1_0_-_......... Prop. Line ---___________________ , REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- ------------------ Date -________________________________I SepticTank-(Specify Requirements) --------------------------------------------------------------------------------------------:----------------,-•------- ----------------- Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- --- -------------------------------------------------=-------------------------------------------------------------- ------------------------------ t (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 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 subject to Wor an's Compensation laws of California." Signed ---------------------------- Owner �- --------- Title - -------------------------------------------- (if other than owner) , - FOR .DEPARTMENT USE ONLY kt APPLICATION ACCEPTED BY - ----- ------------------------------------------------------------------------- DATE -----�` g77a BUILDING PERMIT ISSUED ----- ------------------------------------------------------- =--------------DATE ------------------------------------------- ADDI IONAL COMMENTS -- --------- - a f-71. ---X ----------------------------------------------------------------------------------------------------------------------- ---- - ----- --=-- FinalInspection by-- ------------- --------- ---- -----------------------------------------------------------Date - J(PUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev.