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FOR OFFICE USE: n APPLICATION FOR SANITATION PERMIT ---- -�-.�-¢-'--�`-'---------, --------- � � � � Permit No. /U_`- (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 isting Rules and Regulations: JOB ADDRESS/LOCAT -------------- ------ -- /..... ------- �' to °�`ICENSUS TRACTx f� Owner's Name _ t�- --------------------------------------•---------------------- ---- Phone ------------- ----------------- AddressJ v ---------------------------- City -- -------- --------------------- Contractor's Name ----------- -- ------- - -------- ---------- -------- # .e .TZ.Phone Installation will serve: Residence ❑ Apartment House f-] Commercial ❑Trailer Court ;[] - Mo'tel ❑Other - - _-- ------------- i. -- --- -- Number of living units:_.__��7Number of bedfoorris _,__��___-.Garbage Grinder �__._ Lot Size __________________________________________ Water Supply: Public System and name ---------------------- ----------------------------------------------------------------------------------------Private' Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay•Loam:0 Hardpan ❑ Adobe Fill Material _—!A�_ If yes,type --------- ------------------ (Plot _ _______________(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,] f PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size__________________________________________ ____ Liquid Depth.____________________.___ Capacity ------------- Type -------------------- Material---------------------- No. Compartments ------- t p Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------------.:.._..... N LEACHING LINE [ ] No. of Lines ---------- __ Length of each line----------- Total Length --------- ----------------____ 'D' Box .____ ------ Type Filter Material --------------------Depth Filter Material -------------------- ----t I Distance to nearest: Well ------------------------ Foundation ----------------------- Property Line. -----------------------.--- S1=EPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------------- Rock Filled Yes C] No (3 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line ____-____--____-____- 'V REPAIR/ADDITION(Prev. Sanitation Permit# ___________________ ------------------------ Date -- ---__----________________ - f Septic Tank (Specify Requirements) _____________G��✓�c---.---- --_---- - -- ---- =, Disposal Field (Specify Requirements) ---------- ---- j- - Gk'Y.�27 ---------- Q ' ------- ---- --- ------------ - - ---------------- ------------------------------ (Draw existing and required addition on reverse side) ' 1 hereby certify that I have prepared this application and that the work will be done in accordance with Sant Joaquin County Ordinances, State Laws, andRules and Regulations of the Son 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." w Ir Signed -- -------------------- ----------------------------'Owner By ------------ ----- -E. � ------ -- ----------- Title --- - ------------------------------------- ------------------- - therthan owner] . PARTMENT USE ONLY APPLICATION ACCEPTED' BY ------ - -- --- - - - - ---- ----------------------------------------------------------- -- DATE -------- -------- BUILDING PERMIT ISSUED --------- - --- - ---- - ------- - -------------------------------------------•--------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------ --- ---- - -- ----------------- ----------------------------------------------- ---------------------------------------------------------- ------ ------------------------------------------- --------------- ------ ---------------------------------------------------------------------- -------------------------------------------------� --------- ----------------------- -- ----- -- - ----- -- ---------------------------------------------------------------------------- Final Inspection by: � f"L_ -- - . -------------------------- __.Date -__-- N UIN LOCAL HEALTH DISTRICT i E- H. 9 1-'66 V. 5M ...