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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT_. ---------------------------------0-- (Complete in Triplicate) Permit Na. --- --------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San a rvLocal Health District for a permit to construct and install the work herein described. This application is made nce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-- . --- ---- -- - ---- ---- -------I_ 3 -- - --____-- -- ----------/T ENSUS TRACT --'� -�-------------- Owner's Name - Qh1 ------- --- = Phone tj� 7 --------- --- - Address ------ -412 ---- ----- ----- - - ----------------- -------- City --- -- - ------------------------------------------------------ - - - - ---- ` Contractor's Name - Gc.)�-- --- --- fc�- --- ------------------------------License # Z6.5=d _7__ Phone Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑Other --- ----------------------------- Number of living units:---/---- Number of bedrooms ----Ej ----Garbage Grinder -- - Lot Size -----* /i-Q _________________ Water Supply: Public System and name -----------------------------------_---- ---------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'[:] Silt❑ Clay ❑ Peat❑ , Sandy Loam ❑ Clay Loam ❑ I 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.) l!J NEW INSTALLATION: (No septic tank.or seepage pit permitted if public sewer is available within 200 feet,) tti 4 PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size______.______-___________:___________.___ Liquid Depth ___________ W /� ---------.----- Capacity ��ff_A-------- Type �__ Moterial_i!:zO No. Compartments W Distance to nearest: Well ____ ' 'l3________________________Foundation -----Zo__________ Prop, Line ------J—_____-_. LEACHING LINE [ ] No. of Lines -----9-_____________ Length of each line------- ----------- Total Length _____ -__-______-- 'D' Box _ .__ Type Filter Material ___ -----------Depth Filter Material _.___f _________________________________ Distance to nearest: Well _______________________ Foundation ------------------ ----- Property Line. __________________...___ SEEPAGE PIT - [ ) Depth -- a?t_`" C1____ Diameter __ __ Number --____..�-____________�_ Rock Filled Yes�` No Water Table Depth - ------ ------- ---------- -------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) SepticTank (Specify Requirements) ------------------------------------------------------------------------------_--------------------------------- --------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------- -------------------------------------------------•--------------- --------------------------------------------------------------------------------------------------------------------------------------- (Draw existing 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 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." Signed ___ti_-- - -- Owner BY!' 6�l1 ---------------------------------- Title ----- ------------------------------- ------------------------------ (if other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------ ------ DATE -47--.7--,7�----------------- BUILDINGPERMIT ISSUED --------------------------------------------------------------------:---- ---- --------------------------DATE ------- ----------------------------------- ADDITIONAL COMMENTS ---------------------------------------------------- ------ ------------------ --- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- --- - -- ------- ---------------------------------- ---------------•- ------ _. - .-- --- --------------------- ----- �y ----- Final Inspection by: -- ----------------------------------------------------------------------.c' e ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M