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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ -------- - Permit No: (Complete in Triplicate) X, - --------- ---------- Date Issued ---7_-t:."1)2i ______________________ _____-___-___-_____.__.___ This Permit Expires Y 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: JOB ADDRESS/LOCATION .--/%�' ?----- - aC—` CENSUS TRACT x Owner's Name ---/- Q',-- Phone Address -----------4`�`�----f �`'° e-• --C`'- ------------- City ----- � `- Contractor's Name -------- -%�- - - -----•---_ .------License # I1� -3_ -y-- Phone ------------------------------ z Installation will serve: Residence 'Apartment House ❑ Commercial ❑Trailer Court i❑ Motel ❑ Other--------------------------------------------- Number of living units:----- ------ Number of bedrooms i -------Garbage Grinder ------------ Lot Size -------------------------------------------- • Water Supply: Public System and name --------------------- ---------•------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) \ PACKAGE TREATMENT [ SEPTICTANKSize- _.- �n-_.__-_ __.`a.___��_.__--__ Liquid Depth .... .................. Capacity _! �a_ d�Type - __ Material-- - -_.__ Na. Compartments . __Pz.............. Distance to nearest: Well _____67_f' r __._--Foundation ---- —_/---------- Prop. Line ____: -------- LEACHING LINE [►� No. of Lines ------j;;�------___,__zLength of each line------ V-6--” Total Length .-_ "°_-.�...:...__.. I V'Boz_- `Type Filter Material ----5+�_----_.Depth Filter Material ___f_!............_----------------------- Di stance _____________________Distance to 'nearest: Well ------ _`_____.___ Foundation .._-_/G-........... Property Line. -S -_-.............. SEEPAGE PIT [y� Depth -.-o -- -Y_j___ Diamele� -_ .t-__-._ Number ..__--- :;--_______________ Rock Filled Yes [t No .1 Water Table Depth- -YG'- ---------------------------Rock Size 'r -------- Distance to nearest:—Well ---------- _____________________Foundation -___ �__�___.___ Prop. Line _.' _ _....__.. REPAIR/ADDITION(Prev. Sanitation Permit# --------'"-------------------------------- Date ________-_________________________) Septic Tank (Specify Requirements)'---'--'-- _-- --- --------- ----- - -------------------------------------------------------------•------------------------..... Disposal 5 Field (Specify Requirements)—_',-= - ---=--------4----- ------------------------------------------------ ---------------------------------------------------- _. -i Y =r------ ------------------------------------------------------------- ------ ------------------------ G (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 Workman's Compensation laws of California." Signed --------------------------------------------- -- Owner -------- ' ` -------- ` i BY _ ------- � Title ----� --- ------------- c , � (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------- ----------------- DATE ~ G-._ ----------- BUILDINGPERMIT ISSUED -------------------------------------- ----------------------- ------------------------------------------DATE --------------- --------------------------- ADDITIONALCOMMENTS ----------- ------------------------------------- ------------------------------------------------------------------------------- --------------- ---------- -------=----------------- ----------------------------------------------------------------------------------------- --------------------------------------------------------------- F ------------------------------ -- ----- Final Inspection by: ----------------------- -------- -- -Date -. . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'S8 Rev. 5M