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50 - FOR OFFICE USE: ( OL APPLICATION FOR SANITATION PERMIT Permit No. q (Complete in Triplicate) ---- ------------ -------- ---------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with Cei ,unty S?r_dion nc 549 and existing Rules and Regulations: JOB ADDRESS/LOC N r -------2�14--ltf--CENSUS TRACT -------------------------- Owner's Name -.- ------------------------------------------ --------------- ------------------.----------------- Address -------- ✓d, ��----•-r------ -- --------. Cit-- - ,1-.---- . Contractor's Name ---- =-----.License # _. Phone ------------------------------ Installation will serve: Residence T Apartment House❑ Commercial ❑Trailer Court ;❑ ( Motel ❑ 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 E] Peat E] Sandy Loam .2 Clay Loam ❑ Hardpan ❑1 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 --_----:--------_----.----- : Capacity ---------------------- Type ---------=---------- Material----------- - -------- No. Compartments -- -- ............... Distance to nearest: Well ----------I-------------------------Foundation __`_______.__.-_...___ Prop. Line ---------------.------ 4. LEACHING LINE [ ] No. of Lines ------------------------ Length of each line.--------------------------- Total Length .-._.__-________-_--____ 'D' Box ---.-------- Type Filter Material ____________________Depth Filter Material ___._______r_____.____-___-__.._____.____-_ Distance to nearest: Well ________________________ Foundation ------ --------- -_ Property Line ---'-______._____ SEEPAGE PIT ( ] Depth ___________________ Diameter -------- ------- Number -----------a_____._________ Rock Filled Yes ❑ No i❑ ] Water Table Depth ------------------------------------------------Rock Size ---------------------- ' ---------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ___________.___.-_-.__ REPAIR/ADDITION(Prev. Sanitation Permit# _______ ------------------------------------- Date -------------------.___-__________) Septic Tank (Specify Requirements) -------------------- --------------------------------------- ------------- •------- -------------------- Disposal Field (Specify Requirements) ----------------------------- - -- -- ------------------------ ` - --=------------. --------------------------------------- - - -- S � ____________________________________________ _____________A__-______________. ___-_-____ __ ______ _ ________.____._____-----------------_ _ __ _• ___ -----------------------�'- = ----- --------------- `� -- (Draw a fisting d 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, 1 shall not employ any person in such manner as to becomes Iect to Workman's Com . nsation laws of California." Signed ----- ------------------ Owner ` _ BY --------- �other -_ . . _ ----------- Title -- -----�-- "�� ---------------------------- owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY =--------------------------------------------------------- DATE - -w2--P-1,0�� ------------ BUILDING PERMIT ISSUED ------------------------------------------------------------------ ---- ----- -------- ---- -------.._DATE -.----------------------------------------- - ADDITIONAL COMMENTS ------------ ---- ------------------------------------------------------------------------------------------- - ------ ---------- --------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- --------------------------------------------------------------- ------------------------------------------------------ -------------- - -------------------------------------------------------------------------�- - -------------- Date Final Inspection b --------- SAN - JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M