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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a �� (Complete in Triplicate) Permit No. ___ _ _______ ------I---------------------- ----------------------- _---- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 .__pZ/ -_ E_._ � tl .s17 � -_./moo-�f�T_,_ -----CENSUS TRACT -------------- ----------- Owner's Name ---------------------------- - --------- - - -----------=-------------------Phone ------------------------------------ Address v L /?� 1 ------------------------------------- City _ l '1` hJ ---------------------------------- Contractor's Name .___ -c-s-Zf-�C-,rtc-�'--------------License # PhoneJ. � Installation will serve: Residence {Apartment House❑ Commercial ❑Trailer Court ❑ Motel 1❑ Other -------------------------------------------- Number of living units:---1------- Number of bedrooms _____Garbage Grinder ------------ Lot Size --------------- Water Supply: Public System and name ----- --------------- Private ❑ Character of soil to a depth of 3 feet: Sand'E] 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,) aQ PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------ ----.------------ Liquid Depth -------------------------- Capacity ---------------_ Type ____.______- - Material________ __ No. Compartmentsartments __________ ____ ___ 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 10 Water Table Depth ---- ------------------------------------Rock Size ` rte ,�f Distance to nearest: Well -_-- _____________Foundation ___�0________ Prop. Line _.-. __..__ REPAIR/ADDITION(Prev. Sanitation Permit# ---.---..----------------------------------- Date --------------------.-------------} Septic Tank (Specify Requirements) ------------------------------------------------------------------------------- ,.---------------------------..-------------------------- �2------ - �-�' T'P=----------------------- Dis s al Field {S ecif Requirements] -.. _ __ _---------_______ ____ _ ------------------- -------- ------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 a performance of the work for which this permit is issued, I shall not employ any person in such manner as to become ub' ct to)AforkmaiVs Compe ation laws of California." Signed ----- ----- - - - ---- --- ------------------ ------------- Owner BY ------------- -------- ------ ----- itle - -- - ------ - ------------------------------------------ (If other tha own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -- -- ----------------------------------------------------• DATE b V-2,. 7 BUILDING PERMIT ISSUED -------- - ----- --------------- -----------------------------DATE ------ ----------------------------------- ADDITIONAL COMMENTS OlS 3 ------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------•----------------------------------------------_---.O-----_---�---_---------------2----Z-------------_----- -------------------------------- -- - ------------------- --------------------------------------------- ------ - -_ ----Date ---Final Inspection by. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M