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t FOR OFFICE USE: �- APPLICATION FOR SANITATION PERMIT ----------------------------------------- (Complete in Triplicate) Permit No. k ------------ -------------------------------------------- -------------------- This Permit Expires 1 Year From Date Issued 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 ? >L qy Z)THk% (�% -------- --------------- ------------------CENSUS TRACT ---- �S - - - , - ---- --------------- Owner's ---------- Owner's Name -„ r-tikk - '--Zv' s--------------- 9 likq -a ------•--------- Address ----h'S` l------------------------- ------------------------------------------------------------- - City --- - Contractor's Name ....��_ 1_._.- ------------ ------.License # ---------:---- --------- Phone ----------------------------- Installation will serve. Residence 2<Apartment House❑ Commercial ❑Trailer Court ;❑ Motel El Other ------------------------------------------ INumber of living units:_- ------- Number of bedrooms _3-----Garbage Grinder ------------ Lot Size --10----kX4!_S----------- 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.) 1 NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size-------------------------------- -------- - - Liquid Depth ---------------------: -- Capacity ------ -------------Type ----- Material--------'-- J----- No. Compartments ...... Distance to nearest: Well --------------------- --------------Foundation ------- - ------------_- Prop. Line ------------- LEACHING LINE No. of Lines ' [ l ----------------- Length of each line- --------------- ------ Total Length ----------- ................ 'D' Box ------------ Type Filter Mater al”" '' dDepth Filter Material ---------------------------------- Distance _ . _ _Distance to nearest: Well ------ ----------------- Foundation ------------------------ Property Line i r.'. SEEPAGE PIT [ ] Depth -------------------- Diameter€ --------------_ Number ---------------------- ----- Rock Filled Yes '[] No i❑ —�� Water Table Depth ------ ......... ---------------- ------�__`_Rock Size k Distance to nearest: Well.------- -----------------------------Foundation _.------------------ Prop. Line .--------------•-•-_-• 1 ijSPpec Prev. Sanitation Permit# __---_° ______'_ __ ------------ _ Date---------ify Requirements) ----------------- ---------------- ------ - - ---- Disposal Field (Specify Requirements} __ {' _ _- �C"! a --------------------------------- ---------------------------------------------- F -------------------------- (Draw existirig.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 taws, 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 erformance of the work for which this permit is issued, I shall not employ any person in such manner ` as to be e s je to Workmv 's en o laws of California." Signed)------- _ . - - - - -- - - - � Owner By ------------------ ---` ----- ---`------- --- Title (If other than•-owner) ------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ----- - DATE --- - 1 BUILDING PERMIT ISSUED .-- - - --------------------------------------------- ---------------------------- - AD T ONAL�OM uNS ------------------------------------------------ ------------------------------------- 4 "+""`+o�`T + j --------------- ------------ -------- ---- -------------- ----- - ----- ----- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ -------------------------------------------------------------- Final Inspection by: - ----------- ---- -- -------- -----------------------Date --------------°� . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M