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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ `---------------------- - (Complete in Triplicate) Permit No. -----3 Date Issued -- -------r-_--- ------------- -----_------------------------ This Permit Expires 1 Year From 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 ---------------- f-- ��-- -------- f�'� -CENSUS TRACT ----------------------._.. - ------------------------------------------- Owner's Name 7? - -: fE_ =------------------- -------Phone -- ff _�_ G._ Address --------------- ------ �5''_ 'fJl/(1___ City1'�C G_! !�.1,��------------------------- Contractor's --------- ------------- Contractor's Name _________��r�-•�-•�<� ___ ____ ____ ----------License #�Cz_fr�,��_ Phone � _ Installation will serve: Residence XApartment House L❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- _1e Number of living units:----L_-_-__ Number of bedrooms ___-9'__Garbage Grinder _;,_ -------- Lot Size Water Supply: Public System and name ______--Al 74 ------- - ------_----------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt[ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ y 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,) L 1J PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Z:_k/� �5ize______--------------------------------------- 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 ,__ ___...._.._... O �r D' Box __/---_ Type Filter Material __�l-G' --.Depth Filter Material _/___________________________________ r G _ Distance to nearest: Well __5 ____________ Foundation ---� r----__--_ --- Property Line .__ _._. -SEEPAGE PIT ] Depth _ -------- Diameter �� FNumber -___Z------------------ Rock Filled Yes � No i❑ ? 11 Water Table Depth ------ a-/--------------------- ......Rock Size ------- ---r�------------ Distance to nearest: Well ..... ______________________Foundation __ _________ Prop. Line ....tet...____.___---_ REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ________--_-_----_--__--__--______) Septic Tank (Specify Requirements) --------------------------------------- --- ---------------------------- Disposal Field {Specify Requirements) . - -- -_-;w__ ------------------------------------------------------------------------_ _ --.�----R---{-"-- -------E------------------------------ ---------------- ------------------- --------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- (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 Califarnia." Signed - ------ -------------------;--------/--------------------------------�---------------=--------. Owner BY ----------- ----------------- -L� -�rvt'• _- Title ------ Cly a (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -- - - ------ - ---- --- ------------------------------------ DATE . ---_.f_�_2._1_-_.7�------- BUILDING PERMIT ISSU _____....DATE -------------------------- ----------------- ADIT OBJ L COMMENT ---- ------------ ---- --- -- -- ----- ------------------------------------------------------------------------------- --------- -- Y ----- - ---------- ------------------- ------------4 '-------- - -- -- -- - ------------------- ----------------------------------------- Final Inspection by: ------. . -----------Date ---- - �- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M