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a � FOR OFFICE USE: 2 APPLICATION FOR SANITATION PERMIT � d_/b (Complete in Triplicate) Permit No- ---------------------- ---------=-------------------------------------- ------- This Permit Expires 1 Year From Date Issued Date Issued _/------------------------------------------------- -- --_7_'"_ .® <_._._._ vi - 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 .___- `/__©SJI_____ _ , __ M_-t-_ rd�-- -----------CENSUS TRACT -----IlYr_________ Owner's Name ____ _______Phone ._9_J!-3;?_I_3._.-._-_ Addressuts°l ---- ---- ----- -- --- ---- ------------ City ---- ------- ------------- (� Contractor's Name --------------- eJrh% License #` Lj, �l Phone-�� f� Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court ;❑ IMotel ❑ Other -------------------------------------------- Number of living. units:____ __----- Number of bedrooms ____3----Garbage Grinder ____________ Lot Size _______________________ __________________ Water Supply: Public System and name _ ____________ ______________________Private Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ ti Hardpan ❑ Adobe , Fill Material ------------ If yes,type ---------------------------- (Plot plan, showing size of lot, location ofsystem in relation--to wells;buildings;-'etc. must be placed on reverse side.) Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [-]._._SEPTIC TANK[ ] Size--------------------- ---.- ---------- Liquid . Depth ---_--------- _.. ._._ ._ CoIacitY Type ------ -------- Material-------------------- No. Compartments -------------------- 4 Distance to nearest: Well ----- Y _Foundation-_----------_______ Prop. Line ---------------__- LEACHING LINE [ ]i No. of Lines ----------------------- Length of each line-------------------- Total Length ---------------------------- D' Box -------- Type Filter Material ______________"_)__Depth Filter "Material ----------------- --------------------------- 1(--Distance to nearest: Well ________________________ Foundation _--__._-___ __ _________ Property Line -_- -__.__.___....... I A J SEEPAGE PIT [ ] Depth ____________________ Diameter ________________7-Nu. umber ___-__________-___ _______ Rock Filled Yes ❑," No 0 J_141%� ------------------------------------------------Rock Size ------ - Water Table Dept Distance to nearest: Well ___________ _____Foundation __._- _____.-.__ Prop:Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ___________ _______ _ ___________) 4 � Septic Tank(Specify Requirements) ------ - -------------- # ` ----------------------- •---------------------------- Disposal Field pecify Requirements) __________________ _ ---------------------- ----------------------------- } -------------------------------------------- ----------------------- --------- ------------------------------------------ (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 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." i Signed --- ------------------------- Owner - ------------------------------------ BY Title --- ---- -------- --------4fi-j- ----- ----- ---- ----- ---- ------------- - f other n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------A1d-✓y ---•-- ---------------------------------------------- DATE -----�= 7 r ---7P--- BUILDINGPERMIT ISSUED ------------------------------------------ -----------------------------------------------------------DATE ------------------------------------- ADDITIONAL COMMENTS - ----- ------------- Z= f�0------------------- 1 ---- r�. ----- - - ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ----------------------------------------------------------------------I------------------------------- Final ins ection b _____Date - /_`-P- - C/___.____.--------------- OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M