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� • FOR OFFICE USE: APPLICATION FOR SANITATION-PERMIT - --- ------------------ ----------- r . {Completein Triplicatel"§�- . , -----_ - z � Permit No: -- Date Issued --- �. - --------------- ----------------------------- 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: JOB (ADDRESS/LOCATION '� .b d ------------------ ------- - -----CENSUS TRACT --- b_ Owner's Name --------------------------------------------------------------------------------Phone �'xc - Address --------------------------------------------------------- City 0,-- ----- Contractor's Name �CQ �r1 cLicense # ±-``,.- �a'-�-7-- Phone - -3- ---y-L_�-�_ i Installation will serve: Residence D4 Apartment House❑ Commercial❑Trailer Court ;❑ . jMotel ❑ Other -------------------------------------- ---- F Number of living units:--- ------ Number of bedrooms -__3------Garbage Grinder --- ---- Lot Size -__f -J`---- Water Supply: Public System and name ----------- -------------------------------------------------------------------------------------------- Private,] Character of soil to a depth of 3 feet: Sand"--Silt-❑`---•-Clay-❑- ;Peat❑ Sandy Loam .F-] Clay Loam ) I Hardpan ❑ Adobe '0 Fill ( Mate_ral_- �� If es, type -------------"--_____-___ [Plot'plan, � - showing size of lot, location of system 1 elation to wells, buildings, etc. musty be placed on reverse side.) NEW.INSTALLATION: {No septic tank or seep pit permitted if public sewer is available within 200 feet,) 4 PACKAGE TREATMENTI L' [ ] SEPTIC TANK: � Size-- ---Y_�-�--Y___S'�./3-------------,Liquid Depth -----X, -��.--:-•_-- Ca city -1,2-6.o------- Type ----- - ---------- Material-6-e - Nb' _Compartments _� ---------------- once ----- ---------ante nearest: __ ___o , ________ ,wf _ - ___.__ Prop. Line ___--.__--- LEACHING LINE [ No. of Lines ------Z------------- Length of each line---gd----------------- Total Length ------- _--_-__- i 'D' Box _ ---- Type Filter Material ---+__yam_-----_Depth Filter Material _--'11--------------------------------- k � istance to nearest: Well __,574!------------ Foundation _---/_b--------------- Property Line ---.---_-----.. SEEPAGE PIT [ Depth :51. Y----------- Diameter g X>r_�_- Number ------ ---- —------------ Rock Filled Yes e No ❑ Wafter Table Depth ------------------------------------------------Rock Size -----------------k-------------- Distance to nearest: Well ----------------------------------------Foundation ------------- ----- Prop. Line --------------__-___-_ REPAIR/ADDITION{Pr v. Sanitation Permit# -------------------------------------------- Date -_--_-__-_-----_----------1-------- Septic __-_-Septic Tank {Specify Requirements) ------------------------- --------------------------------------------------- -------------- ------------------------------------------------ DisposalField (Specify Requirements) -------------------------------------------------------------------------------------'--------------------------------•-------------- i `--------------------------------j_-______.---.---_---_--_--------------_-------- -----------_--_--_-----_--------------------------`-------------_- ------------m----_ ---------------------_. 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 bistrict. Home owner or licen- sed agents signature certifies the following: i "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 subl Lict to Workman's Compensation laws of California." Signed ---- - t i{ -- - ------- ---.-{- ---- ------------------ --------------------------------- Owner BY F -d` " -F- '--- ----- - Title -- -------- ----- --- r` i (If other than owne i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ` p ----------------------------------------------------------------- -• DATE ------ BUILDING PERMIT ISSUED ----------------------------------------------------------- ----------- --------------DATE . ADDITIONAL COMMENTS -- . -----------___---_-__ ------ - ------ - -- --- { f -------- --- ---------------------' ---- ------------------------ Final Ins ecti ' - ---------- --------------------------Date ------------------- --- p ' SAN JOAQUIN' LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M. ��