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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------- _ (Complete in Triplicate) Permit No. ---- -------- - Date Issued _1773 -7i This Permit Expires i 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 ADDRESSAOC I� /32.1?k 11 . �/ ' ----------- ---------.-CENSUS TRACT -- --- --- - - ------- ----------- ------ -- Owner's Name - - --------•----•-•--•------- -- - _ Address ----------- - /l,_ -- - D'Cit Contractor's Name Y ----------- -- --- ----•----•-----.--•--- so✓--- -- ----- ----- .- .---.License #�C _ hone Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court ',❑ Motel ❑_- _ Other -----__ _ _ _ - Number of living units:_-- _--_ Number of bedrooms_ -_-.Garbage Grinder ------------ Lot Size __ _-___---- ---------------- + Water Supply: Public System and name ------------- --- ----- ------ ----- ------------------------------------------------------------------------------------ -------------------------------• ------------- - ----------Private Ai Character of soil to a depth of 3 feet: Sand' Silt ElClay [IPeat❑ Sandy Loam -E] Clay Loam ❑ Hardpane 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,) PACKAGE TREATMENT [ ] SEPTIC TANK f l Size----------------------------------- -------- Liquid Depth --------- Capacity -------------------- Type -------------------- Material---------------------- No. Compartments - Distance to nearest: Well -------------------- -------------- -- ------------Foundation ---------------------- Prop. Line ---------------_---.,- LEACHING LINE � -- [ ] No. of Lines ---- 'Length of each fine------------------ ------- Total Length ------------- --- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------- ------------ -------•------.----- Distance to nearest: Well ------------------------ Foundatio1.n -_----_-_- ------------- Property Line _----------------------- Depth Diameter f SEEPAGE PIT s [ 1 = Number - Y - •' ------------- ----___ Rock Filled Yes ❑ Na Water Table Depth ---------- - Rock Size ----------------- - i Distance to nearest: Well _---- ----------------- - - __--_Foundation -0� ---------------r----- Prop. Line ----------------- REPAIR/ADDITION(Prev. Sanitation Permit#.-------•------------------------------------ Date ----------_-_-- --- "' i Septic - •-•------------} p Tank (Specify Requirements] -------------------_----_-___- /� ------- ------------------------------------------••---------------------- ---•--------------------•----- Disposal Field (Specify Requirements[ ------C - a-, . Z 1 f- 17.` �-- i ---------- ----------------_-•----_---------- ---__ -__----_ ---__--__._.-- 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 I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nome 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 -------------------------------------------- Owner r --------------- - - By -------------- --------------------- -------- Title -. ----------------------------- (If other than owner) - - - - ----- ------------ ---------- ./ f FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------- _4 --:__-_-- BUILDING PERMIT ISSUED _ ________________ DATE 7=- fes---7�......... ADDITIONAL COMMENTS -------------- ------------------------------------------ --------- ------` --------------DATE -----------------------•- ---------------- ---------------------------- ----------------------- --------------- ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------- --- -- - ina Inspection by: -. _ _--- --------- - - -- --- ----- - -- - ------------------------------- ------��---� - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M "IV