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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT p ----------=---------------=-- ------------------- nt M _ -- .-Permit No.,7O_-. 6 e (Complete in Triplicate) ---------------------------------- This Permit Expires 1 Year From Date Issued Date Issued)/—_,L �_ Q. 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/LOCATON ------!�, ------------------- ------ -----CENSUS TRACT -------------------------- Owner's Name --- - ----------- ----- --Phone Address ---C1 --------- ------- ' _ City --- ' ---,.License # t -� 1 e� ._ Phone __ --2/4/2--- ----------------- : _ Contractor's Name _.___ _ _- - � 4 _ Installation will serve: Residence WApartment House ❑ Commercial'❑Trailer Court i❑ Motel ❑ Other ---------------------------------------`-- f Number of living units:-- ----- Number of bedrooms ---s2-----Garbage Grinder -__--------- Lot Size -.- _- a---- '�`} � .__-_- Water Supply: Public System and name ---------------------- ------------------------- ---------------------------------------------------------------PrivateX Character of soil to a depth of 3 feet: Sand'❑ Silty Clay .❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe '❑ Fill Material -----. -- If yes,type ---------------------------- i (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 { ]i SEPTIC TANK Q ] I Size__________ _____________ry---------------------- liquid Depth --.-_-._---.-_--:_ Capacity ----- ----- -----= Type --------------------- Material-------------------- No. Compartments -----------------:----� Distance` to nearest: Well --°-------------------------1------Foundation ---------------------- Prop. Line --------------- ----_J LEACHING LINE [ ] No. of Lines ---------- Length of each .line-----------------I--------- Total Length _-_-__-_----_--_-_--_-__-� i 'D'. Box .----------- Type Filter Material ---------------\,-Depth Filter"Material _._________________________________---._� Distance to:nearest. Well ------------------------ Foundation ------------------------ Property Line ------------------------ SEEPAGE PIT [ ] Depth t Diameter _ __ _ _ Number ~w^ _ __._ --___~)tock Filled -Yes-[]""""'No i❑ tS _7 T Water Table Depth -------- ------------------=--------------------Rock Size -- ;------------------ ----- Distance to nearest: Well ------°------------------------- -------Foundaton --_-------•---.-.-------- REPAIR/ADDITICN{Prey. Sanitation Permit#._.__-__ _ ___----------------�_ Date ____________________ ___ _ ___-_)Prop Line ----------•---•"•_ 9C Se tic Tank (Specify Requirements) ------- ments)Disposal Field (Specify Require -_ -- h , i --- - + --- - -- -- ------- --- ------------=------------------- -- V --- ---------------- - ------------------------------- ----- - - -------------------------- ------- - - -- -- (Draw existing and required addition on reverse side) I hereby certify that 1 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 "1 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 b mes biegt to Work tin's Compensat'on laws of California." Signed - -- --- --------------- Owner By --------------------------- --- ��, t - ------------------ Title ---- ----- --- ---- ------ -------------------------------------------- (If other than owner) /FOR .DEPARTMENT USE ONLY // APPLICATION ACCEPTED B - ----------------------- DATE _-I,l.:_/ _ _.____------------ BUILDINGPERMIT ISSUED ------------------------------------------------ ------------------------ --- ---------------------------DATE -..-----------------------------------.---- ADDITIONAL COMMENTS --------------- ------- ----- ------------------------------------------ ----------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ------- ---------- --------- - - Final Inspection by: r' = L Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M