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Jam- Y FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---------------- - (Complete in Triplicate) /d-4-10 ----- -------------------------------------------- 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. 5.49 and existing Rules and Regulations: -- -- - - - - --------- -- !-- --- - - CfENSUS T RACT 50-'/-------- ----- one ------ ------------------- --- - - -- JOB ADQRES5/LOCATIO f �Sy� Owner's Name Address ---------------- City :- '� �'L1` Contractor -___.__ - f .License # 1�` Phone -------------•------------•---- Contractor's Name -- Installation will serve. Residence Apartment House'❑ Commercial Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:-------J,_ Number of bedrooms _- ______Garbage Grinder ____---____ Lot Size -1---1Z Number _ _ F Peat Sand Loam _ _______ Private i Water Supply: Public System and name ------------------ - -- -- --- ---------- --_-___---- - Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ � ❑ Y Clay Loam I 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.l P ..' 1 P seepage pit permitted if public sewer is available within 200 feet,) r NEW INSTALLATION: (No septic tank or �r SEPTIC TANK' Size = r = Liquid Depth -------------------- PACKAGE TREATMENT [ ] [']�-- - -- Capacity Type `Material__ --- No. Compartments -------------•---=---• PY ------------ Distance to nearest: Well ------------------ oundation ---------------------- Prop. Line --•------- ------ ------ Length of each: ine ----------- ------------ Total Length LEACHING LINE k [ ] No. of Lines --- j--------Depth Filter Material -------------------- ------- ---------- /.'-Foundation ----- - . 'D' Box ._________._ Type..Filter Material _,__�_ _ �"' ------ Property Line ----------No=- -- Distance to nearest: Well _------------ -=------ Foundation _.__--'----_----- P tY SEEPAGE PIT [°] Depth -------.------ ----- jDiameter ---------------- Number ---------------=--- Rock Filled , Yes ❑ 4 R• s Water Table Depth '----- - Rack Size ;. - -------------- - - { i ,�r Pro Line ..--------••-- fs.. Distance to nearest: Well -,w_�_;-,--_--_--------�------------Foundation ------------------- P -• Date ----------------- ---------------------- ---------- REPAIR/ADDITION{Prev. Sanitation Permit# --------------•--------- - Septic Tank (Specify Requirements) __------------------------------ s i s Jr Disposal Field (Specify R quiren�ents)�.__a } ---- ------------------ E --- _ - „, ------------------------------- F---------- 9 t ------------- ---------- ------------ R {Draw existin and required addition on reverse side) I hereby certify that ! 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 Ncen- ` sed agents signature certifies the folliowing: "I certify that in.the performance of the work for which this permit is issued, I shall not employ any person in such manner to Workman's Compensation laws of California." as to become su�q Signed i (�� . Owner Title - c '- �• - If other that+ owner) FOR DEPARYMENT USE ONLY APPLICATION ACCEPTED.,BY -------------- --------------------- ------------------ -------- DATE ------------------------------------------- = DAT BUILDING PERMIT ISSUED ---------------------------- -------------- jADDITIONAL COMMENTS ---------------------------------------------- --------------- ----------------------------------- --------- --------------------------------------• - ---- ---------- --- ------------- -------------------------------------------- ---------- -- -- - ----------- ---------- Date ---- -- Final Inspection b ----- ---- ---- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT € E. H. 9 1-'68 Rev. 5M.