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R OFFICE USE: ',APPLICATION FOR SANITATION PERMIT �1 6� --------------'W "G- Permit No. _ -------- (Complete in Triplicate) j Date Issued This Permit Expires 1 Year From Date Issued i 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: / a----------------------------------- -CENSUS TRACT -------------- ----------- j JOB ADDRESS/LOCATION .--�-f�------ '-- ff��hd=�,� _ ----------------------------------------------• Phone { 2 Owners Name ------7�0 --- -L� + --- Y = � Li ------------------------------------- Address ------- ��-�`�-------------------------------------------------------- ------•--- Cit �L_ . Con#ractor's Name ? � f'�, l�'---------------- ----=-------License # 9 Phone j[2_'- �10`_.. Installation will serve: Residence XApartment House❑ Commercial :❑Trailer Court i❑ I` Motel ❑ Other -----� -----------------------------------•- Number of living units:___--___ Number of bedrooms _,;�_�__Garbage Grinder'A0--- Lot Size -°> - -�- � Water Supply: Public System and name - 1 ---- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt ElClay E] Peat E] Sandy Loam ❑ Clay Loam El 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK'[ I Size------------------------------------ ----------- Liquid Depth ----------------------•• Material---------------------- No. Com artments Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------------------•--- Length of each line - -----------------Total Length . S_' = LEACHING-LINE [ ] No. of Lines ---------------------- - g D' Box ------------ Type Filter Material --------------------Depth Filter Material'�_"'_-- Distance to nearest. Well_________________________ Foundation ------- ----------------- Property Line -____--________.--._-.-- SEEPAGE PIT ] Depth Diameter ---------------- Number ____________________________ Rock Filled Yes ❑ No a . Water:Table Depth ----------Rock Size ---------- -- ------------------ Distance to nearest: Well ----------------------------------------Foundation ---------------:---- Prop. Line --------.------.------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------------•-•-----•--------- Septic - :----Septic Tank (Specify Requirements)LL---------.------- - --------- ---------------------- ---------- --------------------- - = -- --------------- Disposal Field (Specify Requirements) _': ------ ��{'.......� � ' - ( g q ----------------------------------------=----------- Aw-existin and reed addition ----------- -------------- dition on reverse side) ' I ereby certify that I have prepared this.application,and that the work will be done in accordance with San Joaquin ions of the San Joaquin Local Health District. Home owner or licen= County Ordinances, State Laws, and Rules and Regulat r sed agents signature certifies the following: `z 'j ;ertify 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 BY = �_ - ---------- .... Title --------------------- �r .CJ-� i o er than owner) P L �FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- -- - DATE 1 .P BUILDING 'PERMIT ISSUED ----------------------------------------- --------------DATE ------------------ ADDITIONAL COMMENTS D �P- - �' '--------------------- ------------------------------------- ,--• --"---. - -� ------��--- ------------------------- --- y -- c�r a- --------------------------- ----------------- -------------__ ----------- - -------- ----------------------------------------------Date ------1 6 `3= �------------ Final Inspection bY� -------- ----- ------- ----------------- --------------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H."9 1-'68 Rev. 5M