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� e FOR OFFICE�USE: APPLICATION FOR SANITATi3ON PERMIT �/- - Permit No- -- --------------- -- (Complete in Triplicate) r1Date Issued f�1l- ` ' 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: �� lrC� SUS TRACT ------------------------• JOB ADDRESS/LOCATIO ----.----- -�? ----------- ." - Ve Owner's Name - ------ +-5r -------------- --- - --- ------ Phone Address ---------- A-Z--r ----------- ' •-' -ft City a� - c --.---------.License #* if`j_..7---- Phone ,3��p- Contractor's Name ___-____..__� �'-�- ---��- �--- _- _ _ Installation will serve: Residence)irApartment House❑ Commercial:❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Lot of living units:___. Number of bedrooms _______Garbage Grinder 4 -7--- Lot Size -- _. - �p•-- Water Supply: Public System ancf name '___ _ ---._.44 trOW ____.___. _ --- J' .- rivate Character of soil to a depth of 3 feet: Sand ❑ Sift❑ Clay ❑ —Peat ElSandy Loam E] a oam 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.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,} S PACKAGE TREATMENT )?° SEPTIC TANK:( S ----------------- Liquid`Depth __-_- --_--------,----- °��r,. No. Compartments Capacity��pQ ----- TypeAa;,�A�4_ateriol----� - - --+�- ----=---- s Distance to nearest: "Well ----- -------------------Foundation ----1d_-------- Prop. Line ------- -�.-------- LEACHING LINE No. of Lines ------ _____________ Length of each line.- -S--------_----Notal Lengthi ,._ --r--------•• 'D' Bok ---`---- Type Filter Material _A -----Depth Filter Material _____ - -1---------------------- "` Distance to nearest: Well - 7--.--_ __ Foundation ____� _____-_- Property Line SEEPAGE PIT Depth _ -_.__ Diameter -��. Number ____.__ _________ --(Rock Filled Yes No i[� Table Depth --------- ---------•------....: Rock Size Q ----------------------- Water Distance to nearest: Well ----- f1l--. ______-_______...Foundation ___��____. -- Prop. Line REPAIR/ADDITION(Prey. Sanitation Permit t-------------------------------------------- Date --------------------- ------). Septic Tank (Specify Requirements) -------- ----------- '------------------------------------------------------- ------------------ - -------------------------- Disposal Field {Specify Requirements) ------------------------------------------------------------------------------------ > ------------------------------------------------------------------ ----------- -------------------------- - ---------- ------- --------------------------------------------.--- --- ---- ---------------------------------------------------- (Draw existing and required addition on reverse side) I hereby'certify that I have prepared this application and th at, the work will,be done in accordance with San Joaquin l 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: w _1 "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 -- ------------------/---j--------------- --------------------------- --------------------------- Owner ' -} BY J Title --- '�'" Tf of thaw n owned --------�- . 1_ ' I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- _ 1-- -- -------------------------- ---- ----------------------------- DATE -_ --- ---7/---------------- BUILDINGPERMIT ISSUED ----- --------------- ------- ------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------- ------------------------------ ---------.------------------------------- ------------------------------------------------ ---------------------------------------------- ---------------------- ------------------------------------------------------------------------------------------------------------------------- - - -- ------------------------------------ - ----------- - ---------------------------------------------------------------- -------- o -- ------ - ' --- --- Final Inspection by: --- - --- --- - ------------------------ Date _ V SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M