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FOR OFFICE USE- I-, APPLICATION FOR SANITATION PERMIT -7 --------------------- ----------------------- ------ (Complete in Triplicate) Permit No- ------------------ -• --------------- -------}�. l� 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. 549 and existing Rules and Regulations. JOB ADDRESS/LOCA QN .---- - G- �----- -------?`-J`�--------~- -- �--�4�-"---------CENSUS TRACT ----------------- - 4�'----•----.... Owner's Name --- - -!---- -- -- -- --•--- ---------------- Phone Address -------- © -- ----- --------- " •.. City --- '�� ----------------------------------------------••----- ----------------------------- Contractor's Name ------ - 44ze, 7A,.4-----.6�,-,--_License # JZY:TZ j ---- Phone Installation will serve: Residen a [L<partment House❑ Commercial ❑Trailer Court ',❑ 11 Motel ❑ Other ---------------- -----------------------•-•- Number of living*units:--------I--- Number of bedrooms _Z______Garbage Grinder ------------ Lot Size ___________________.:_____.._________._ Water Supply: Public System and name ---------------------------------• --------------------------------------------------------------------------Private, Character of soil to a depth of 3 feet: Sand'❑ Slit❑ Gay ❑ Peat❑ Sandy Loam ,E] Clay Loom Hardpan ] Adobe ❑ Fill Material ------------ If yes, type ____________________________ (Pl'ot plan, showing size of lot, location 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 sew r is available within 200 feet,) . PACKAGE TREATMENT { ] SEPTIC TANK'[] Size_ ,Y_.`3 _ 5 Liquid Depth T----•--------- ---- Capacity LL0Q___ ype ___ Ma�eral_ ____ �e No. Compartments _',.�. ,. . . ._ Distance to nea est: Well -------5,aP________________Foundation.___ 1_p-__---__-Pro`p.—Line ..... -------- LEACHING LINE [�] No. of Lines 'T - T - .- Length of each line_____ "°. __ __.______ TotaE"Len�th ___r_ . 'D' Box -----I____._ Type Filter Material _____Depth Filter Material ------------------------------ ------- Distance to nearest: Well. ��__�_____ Foundation -------/_Q__r__` Property Line -- ................ SEEPAGE PIT [� Depth ---- _47------ Diameter ---3_3...... Number ---- ----- .3--- ___ Rock Filled Yes No i[I r Water Table Depth -----------------kv-A_..----------------Rock Size --- `dam - -- Foundationr.� -/ 0 Prop. Line _____ _........... Distance to nearest: Well ____________________�_ ___ REPAIR/ADDITION{Prev. Sanitation Permit# __________________________________ Date ----------°:_______.__.._---.-_-__� Septic Tank (Specify Requirements) -------------------------------------------------------- = ----•------------------------------------------------ ------ s Disposal Field (Specify Requirements) ____________ — r ------------------------------------------------------------------------------------------------------------------ - ----------- ------------------------------------------------------------ •---•----- --------------------------- (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 mannef as to become subject to Workman's Compensation laws of California." ,. Signed------- ------------------- ---------------- Owner _ By --------------------------------- ------ ------------ Titlei - ---------------------------------- (If other than owner) - } Y - _ ; r, i ti FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - ------------------ DATE &_`.�_ _�T - -- BUILDINGPERMIT ISSUED --------------------------------------------------------------•--•----------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS - - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- P Final "Inspection by: ------- t = ----------------------------------------------------------------------- Date - �. __ --- - ---_._------ SAN JOAQUIN LOCAL HEALTH DISTRICT IV E. H. 9 1-'68 Rev. 5M