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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Pe (Complete in Triplicate) - ----------•---------------- rmit ---------- ---------------------------_.----------------------------- 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 existing Rules and Regulations: JOB ADDRESS/LOCATION ` --- ]��-- ---- - n----- ---- SUS TRACT -----------------••-_--•- Owner'�s Famed--e1�. i ® __^ - ---------------- Phone Address�. �i1 - -----------`---------------------------- City -`--------------------A16, - Contractor's Name 411YX JA-.--!6 if -_ 4S'"1-0 _-- :License # &-6 Phone Installation will serve: Residence I Apartment House❑ Commercial ❑Trailer Court r Motel ❑Other -------------------------------------------- Number of living units:-._ ---____ Number of bedrooms ______Garbage GrinderloAnkot Size ____ --- -----------------______________ Water Supply: Public System and name -------------------------------------------------------------`------------------------------------------------Private t'T Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:&", Hardpan ❑ Adobe.0 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: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) W PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-------------------------- Liquid Depth -------------------------- ` Capacity P Y Type Material s--- ----------------- No. Compartments ----------------- Distance ----- ..-.Distance to nearest: Well ------------------------------------Foundation --------- ------------ Prop. Line ______________._-..__ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length --------------- ------------ 'D' Box ------------ Type Filter Material ___________________Depth Filter Material ___________________._--___________,__.______ Distance to nearest: Well ________________________ Foundation ------------------------ Property Line --------_-________._____ ' SEEPAGE PIT [ ] Depth ___________________ Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No ,0 Water Table Depth ----------------------------------------- ----Rock Size -------------------------------- Distance to nearest: Well _______________________________________Foundation -------------------- Prop. Line -----------........... i REPAIR/ADDITION iPrev. Sanitation Permit# --------------------------------------------- Date ---------------------------------- Septic ----__-_.._ _-_Septic Tank (Specify Requirements) ---- . Disposal F' Id {Specify Requirement} ___ +____ .+ � = `""L ---------------------------------------------------------- ---------------------- - ------------------------- - -- ----------------------------------------- ----'------------------------------------------------------------------- --- ------------------- fDraw existing and require ddition 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." j Signed q� ------------------- Owner BY �d -{� Title _�. � --------------------------------------- -- --------- (if otheWhan o err FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ------ ----- . --------------------------- ---------------------------------- DATE BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS 1 - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- ----------------------------------- Final Inspection by: -- - ----- - - , --------------------------------- .Date�a.M SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M i