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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit M3'��ld--�'�---�----- ----------- ---------- -------------------------- (Complete in Triplicate) Date Issued ./�`:✓s 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 arid-Regulations: ------- --- JOB ADDRESS/LOCATION ..I_ [ l �_ ---C ----- --------------------- ----- _CENSU TRACT ------------------- Owner's Name ---------------- -- ------- -- --------- -------Phone ----- C �oZL.�._ - ----- -- --- - ----- - - Address - --- Contractor ------------- s Na ---- ------.License # 1� ,.3c�' Phone Installation will serve: Residence E]Apartment House.'❑.Commer ial [_]Trailer Court 01 yJ. Mate! ❑Other ------- --�*--`--"� ' ,� Number of living units:-------- Number of bedrooms ------ ".-Garbage G inde Lot.Size.___-�_ �'-� ---- i Water Supply: Public System and name __________________ _____._--------- Private Character bf'soil to a depth of 3 feet: Sand'❑ Silt❑ i Clay ❑ Peat❑ Sandy Loam lay,Loam :❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ----------------------------- {Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank or see ge pit permitted if public sewer is available within 200 feet,) 01 PACKAGE TREATMENT [ ] SEPTIC TANK ] *Size___-_- -g---x-=--- -------- Liquid Depth __ ------------------ 1 a ,-----�-J- -- -Material_�__(L=�, - No. Compartments __--•-.--_--- Q I Capacity - Q� �_ - Type!#"�"""� if f ` F 1 ------ ,/Distance to nearest. Well ----------- ------------ --Foundation on rte_-______--- Prop. Line _- -------•,------ 1. L- �. L•ength�of each-line.- 9 -'---------------- Total Length � a--,------------ LEACHING LINE [ No. of Limes �__._._ D' Box __y__.__._:Type Filter Material _S _____ __Depth Filter Material -------ilp to nearest: Well- �!:�- -=- -~ Foundation' ------p--f---------- Property Line,;__-�-------------•-- SEEPAGE.P.LT.,..-.[.]�..-� Depth �__,, Diameter Number Rock Filled Yes ❑ No 0 WaterTable Depth --------------------------------------- --------Rock Size ---- ------------------------=-- . i ---Foundation -------------------- Prop. Line - ------- REPAIR/ADDITION -- -- Distance to nearest: Well _______-___________________________ - REPAIR/ADDITION(Prev. Sanitation Permit°# -------------------------------------------- Date __---_---------------------------) t Septic Tank (Specify Requirements) ----------- -------------- ------------------------` ------- - -------------------------------------- Disposal"Field-{Specify.Requirements) -------------------------------------- ---------------------------- - ---------------------- ----------- ----------------- )----------------- ------------------ ------------------------------------ --------- ---- - ;. (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- 4 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 subject to Workman's Compensation laws of California." Signed ----------------- Owner _ 9 Title ---------- ��,n+ --------- -------------------------- (If ;i ----- other than owner) FAR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._ ------------------------- ------------- DATE _/._.r? ---------------- BUILDING PERMIT ISSUED ------------------------------------ ------- - -------DATE ------------------------------------------- ADDITIONAL COMMENTS -------------- - ------------------------------------------ ----------- ---------- ------------- ------------ --------------- ----------------------------------- ---------------------------- +` ------------------------------------------------- Dat --------------------------------------------------- -------------------- ------------- - ------- ------- - -------------------------------------------------------------- E Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT j E. H. 9 1-'68 Rev. 5M.