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FOR OFFICE USE: � APPLICATION FOR SANITATION PERMIT - -------------------- (Complete in Triplicate) Permit No. ----------•- --------------------------------------------- - -------------------------------------------- ________________________________________________________ This Permit Expires 1 Year From Date Issued Date lssuedl�_.3O 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 comp i nle with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .- /�cam- --�Ic -------P,;' s.vkic---------------------- CENSUS TRACT -aS''�. � Owner's Name �j �^. V fm� G�} -------------Phone ------------ Address ---------- 4 city 7�.c '� ------------------- ----- Contractor's Name Sj '---- '✓----------- ---------.License # ---------.- ------ Phone ------------------------- , Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -------------------------------------------- - Number of living units------ Number of bedrooms r _______Garba_ge Grinder __________ Lot Size _____________________ Water Supply: Public System and name ------- --- ---------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay E] Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _ - If yes, type ---------------------------- i (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 [ ] Size------------------------------------------------ liquid Depth -------------------------- Capacity --------------------- Type -------------------- Material---------------------- No. Compartments ---------__.____ -__ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------- _------ LEACHING LINE [ ] No. of Lines ________________________ Length of each line-----__.-__------------_--- Total Length --___----___.___- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----_----------------------------- ......... + Distance to nearest: Well ________________________ Foundation ------------------------ Property Line. -----.__..______._._.___ SEEPAGE PIT Depth __________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well --------------------------------•-------Foundation -------------------- Prop. Line -----------------•--•- REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ----------------------------- Date ----------------------------------I SepticTank (Specify Requirements) -------- -----------------------------------------------------------------------------------------------------•... -------------------------- . Disposal Field (Specify Requirements) _______ C�r` .�c. ,-,___Q __ --1� _/.. _-�-----------•----------- ,f ---------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------v---------•--------- (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 Workms Compensation laws of California." Signed __'�yg-,g.....1__,__W-- -------------- Owner By -------- ---- - - - - -- - - - -- - ------------- {/ --------------- Title ------------------------------ - (If other than owner) FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY ------- —-------------------------------------------------- DATE ----10_--,3Q 7 BUILDING PERMIT ISSUED - -� DATE ----------- - r ADDITIONAL COM NTS X CYC -_ _ _ r-c.eGr� --------------- --------- - - 7 . �� . ------ - - ----------- -- ------ rZ �uraFsT�__arr�-+=_ �+ -s2�d lr..«rY FinalInspection by; ------- ------------------- --------------------- ------ ------- ---------------------------- -Date �Jr SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �