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FOR OFFICE USE: APPLICATION FOR iANITATION PERMIT ------- ------ - Permit No- ----�_`�d_.f ----------------- (Complete in Triplicate] ------------------------------------------------------------------ ------------- icc -4-4 ____ ---------_---------------------------------- This Permit Expires 1 Year From Date Issued Date Issue ___ 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 existi R le .a d Regulations— JOB ADDRESS/LO TTION __._ _._f _� -�(t7,,j � � % CE SU TRACT _________________________ Owner's Name 9 f� ry -- Phone - ------- Q --------------- Address -aQ----- Address ----------f --------- City ------ --------------------------------- -A-4—�, - - - - -Lam`/ �7 Contractor's Name r '�'"v'"� =- License # ------------------------ Phone+M.- � ! Installation will serve: Residence Apartment House❑ Commercial [7]Trailer Court ;]] Motel ❑Other ---- --------------------------------------- �/� Number of living units:--- Number of bedrooms -_ _____Garbage Grinder A/P----- Lot Size --- Water Supply: Public System and name - ------------------- 3.., --------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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) rn � fr r PACKAGE TREATMENT [ ] SEPTIC TANK[ ] SSiize------�X--9--�------------------------ Liquid Depth -------------------------- � Capacity - W-0--,q Type XAf)(55!-5TMaterial -Ot_ No. Compartments � _-_____. C Distance to nearest. Well ------- ___________________Foundation ____-_f p_-_- Prop. Line _ d LEACHING LINE [ j No. of Lines -_ ______'______ Length of ear line____�d________-_._-_ Total Length ____ _Y ------___.. 'D' Box ------------ Type Filter Material _ . ---.___Depth Filter Material _____l_____ _________________________ P, � r Distance to nearest: Well -/40______________ Foundation _.�S_.____.________ Property Line -___.__.___ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ❑. Water Table Depth ---------=--------------------------Rock Size -------------------------------- Distance to nearest: Well ---------------------------------------Foundation -------------- ----- Prop. Line _.-.-___-.____-_----__ REPAIR/ADDITION(Prev. Sanitation Permit# _._ ______ ------ --------------------- Date _____________;__________-__-_-----) Septic Tank (Specify Requirements) ---------- -- �` -- - --------------------------------------------------------- Disposal Field (Specify Requirements) ____ ___ ,---- / ----- - ------------------------------------------------------------------------------------------------------------------------------------------------------=---=----------------------------------------------- 11 (Draw existing and required addition on reverse side) ` 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 liven- . 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 ------ •----------- --- ----------------------------------------- Owner , � r By ---- ---'-- - -- ------------------------------- Title ---------------------- --------------------- --------------------------- if r than owner) a s- FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------ - ---- -----------/----- ------------------------------------------------------------ DATE - _: L _ ------------------- BUILDING PERMIT ISSUED . ----- -- ------DATE ------------------------------------- ADDITIONAL COMMENTS f----------------------------------------------------------- ----- ----------------------------------- --------------------- /--------- ------------------------------ _------------------------------_-------------------- ------------------------ -------------- - - ----------------- --------- --------- -- -------- -------------- --- ---- --- ------------------ Final Inspection by --------------------- ---------------- Date -- o`�"�1= ----------------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -`sE