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FOR OFFICEIUSE- �b APPLICAT:ON FOR SANITATION PERMIT �U r- = -- ------ a _ .- -' �------ =• Permit No: _.7s)-------------- 9 1 7__.. 9 � (Complete in Triplicate) j -------------------------------------------------- Date Issued,._--! :_7i7 --------------------_------------_------------------------ 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 GGc]]ompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION A-1-31-7....... _..__------ -- -------- - -- - -- .-----CENSUS -� _ ---- -------- - - - --- - - TRACT --------------.._...------ Owner's Name -- --------- L ------ --------------Phone Address ---------------------------------- ----- ---------------�__ _ --- ---- City -------------------------------------------- ------------------------------ Contractor's Name -_ _ ---___ _____ License # __ Phone _ _4-_-1 �- Installation will serve: Residence 'Apartment House❑ Commercial ❑Trailer Court 10 Motel F1 Other -------------------------------------------- Number of living units:-----/----- Number of bedrooms ---Garbage Grinder ------------ Lot Size ----------- Water Supply: Public System and name ---------------------- --------------------------- -----------------------------------------------------------Private ❑—� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ 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,) i _ / 11 [ PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-_ _._ Liquid Depth -_V----2_------------- W Capacity ------ Type __ Material--- ? No. Compartments ____ - -'::..__...� Distance to nearest: Well ....75_ ___________-_-___..Foundation __._ -------- Prop. Line --- LEACHING LINE No. of Lines _ -_ _ Length of each line.____. L l g � / �� - Total Length 7�------------- D' Box ..__1.-..__ Type Filter Materia( .Fd�-____Depth Filter Material _._ `4__ ___________ e ' I r � Distance to nearest: Well -_l _____________ Foundation ____ _�__________ Property Line -- ___.____-_________ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number .___________.___ Rock Filled Yes ❑ No (03 Water Table Depth ------------------------------------------------Rock Size ------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................-- Z,RiPAIRfADDITION(Prev. Sanitation Permit# ____________________________________________ Date _______-________________________) SepticTank (Specify Requirements) ---------------------------------------------------------------------------------•------------------------- -- -------------------------- 1 Disposal Field (Specify Requirements) ---------------=--------------••------------------------------------------------ ------------------------------------ ------ 4 ----------------------------------------- ---------------------- --- -------------------------- ------------------- - i {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 manner as to become subject to Workman's Compensation laws of California." Signed ------ ----- - - , yl s�� -----f ------ ------------- Owner 115 Or By - --- �- ------- f/ Title (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY T ----------- - - ---- -- ---------------------------------------------. DATE ------ --" d------ BUILDING PERMIT ISSUED ----------------------------- ------------------------------------------------------.DATE ------------------------------------------- ------ ---------- ADDITIONAL COMMENTS --------------------------- ----- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- -- ----------- Finaly: ---- ---------- Inspection b - ---------- -----------------------------Date -- -----------------P SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'S8 Rev. 5M t