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•OFFICE USE: _ APPLICATION FOR SANITATION PERMIT ---•----•--•---- ---------------------------------------- (Complete in Triplicate) Permit No. ------- '--------- �.____-____ 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 --,1/� �- )��-----5F---?----r,0W_1)CtNSUS TRACT --__-------------•------- Owner's Name ----�' � ,�J��j-----� /:�A - =y� Phone • ` - `L� °' CitY / x ----------------------------------------- Address Contractor's Name ---- �� LSP --------------------- 2 ---------------License #`��.��__--- Phone��,� ------ Installation will serve: �� -ResidenceA]-Apartment House❑ Commercial ❑Trailer Court Motel ❑Other---------------------------------------•-•-- Number of living units:--- ----- Nmber of bedrooms ______Garbage Grinderh:S___ Lot Sizef___eFel-e_____________________ 1 Water Supply: Public System and name ------------------------------------------------------------------------------------------_------------------Private$[ .J "C#icrr—acter of-soil to a depth of 3:feet:- -Sand ❑ Silt❑ -Clay'*❑: Peat-ED.&Sandy Loam ❑ Clay Loam ❑ �. F 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.) \ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) \ PACKAGE TREATMENT ) SEPTIC TANK ) Sizej . _---________________ Liquid Depth !il _______....,..... v Capacity / -� -.-- Type�0,V�`'Gr�_ Material- _-F- No. Compartments --_-0-----------_._ C.y Disfance`to nearest: Well -----��------ ;g ----•---------Fo�dation --'��----------- Prop. Line -_.�..--.---------- .. � LEACHING LINE [ ] No.: of Lines u , _______ _______ Length of each line__ G�__�__.__,_-- Total len 2 C��_.. ._...... D Box yC� -___ -Type Filter Mater�all_ , � Depth Filter Materia] _17_______________________________ \ Distance to nearest:'Well ._ Foundation e ------ t�(�------------ Property Line. ---Z�= -------------- SEEPAGE PIT [ ] Depth _fi _____ Diameter _ ----- Number _-_ ___________ ______ Rock Filled Yes o No C r "e.W, Water Table.,Depth --------~�Q-----------------__--•------Roc-k Size-// 3------------ Distance ------- --Distance to nearest: Well _-._` _-__:I_______________Foundation - _ -_ Prop. Line ___. REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- - ------------------- r Date -------.--------------.._. SePic Tank (Specify Requirements) ------------------------------------------------ --------------------------- Disposal g� Field (SpecifyReuirements) ------ = --------------- >--------------- _ """'""{brave existing and required addition on reverse sideM �`'- 1 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, I shall nor employ any person in such manner as to become subject to Workman's Compen Qtion laws of California." Signed ---------- ---- ------ ---- ------ -- Owner BY '_---- ------ /�✓.-_ ` -------- title 1 -- ---------- ------------ er than owner] I FOR .DEPAftTMEIVT [ISE ONLY APPLICATION ACCEPTED BY ------------- -----. DATE -- -" -- -------------------------------------------- BUILDING PERMIT ISSUED ---------------------------------- - - ------------ --------------DATE ----- --------------------------- ----- ADDITIONAL COMMENTS --------------- ---------------------- ------------------------------- l = --------- - ----------------------------------------------------------------------------------- -- Final Inspection by: ------------Date --' Q SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M