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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT / -- --- ------ ---X---------------------------------- Permit No: ---- �'a (Complete in Triplicate) ----------------------------------------- j/ 7fc ___ _______________________________________________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for aper mit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: � �"7- JOB JOB ADDRESS/LOCATION r --- -------------- ----- - -------- ----CENSUS TRACT -----------------------_ I _ _ 6Owner's Name ------&&;U4eN -----XXJ/ � ------. --------------------Phone 5 a - Address - Cit AAji FP---- -----------------------------------•------ Contractor's Name --------- e._" 4----- -� e�Ce-- ----------- -- 1�- �- - -----------------------License # -------------------------- Phone ---�Cl`�yS�---- Installation will serve: Residence [(Apartment House'❑ Commercial :❑Trailer Court 'E] f Mote) ❑ Other -------------------------------------------- Garbage Grinder _-------- Lot Size ____________________________________________ Number of living units:---f------- Number of bedrooms -----/---- Water Supply: Public System and name __________________________ fj ❑ �r � - i9e1 7/ lZ`4'-�- Private Character of soil to a depth of 3 feet: Sand'fW Silt❑ Clay ❑ Peat ❑ Sandy Loam .0 Clay Loam ❑ "Hard`pan❑'A`clobe:❑" Fill Matef�al --�`--�"If Yes,type - }-------------- [Plot plan,.showing size of lot,ilocatioh 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 J------------------ Type ------------------ Material---------------------- No. Compartments ---------------------- Distance to nearest: Well -------------- ----------Foundation ---------------------- Prop. Line ----------...__.----- � LEACHING LINE [ ] No. of Lines ---------------- Length-df—each`line---------------------------- Total Length --------------------:------- 1t1 ti 'D' Box ------- Type Filter Material;_ _____-_..._.....Depth Filter Material .........1.... .. Distance to nearest: Well __.______��____'__I___ Foundation ------------------------ Property; Line ________________________ --I SEEPAGE PIT [ ] Depth _ __________________ Diameter _____- �__T----1 Nurib ---------------------------- Rock Filled Yes ❑ No i[] Water Table Depth ------------------------ Rack Size T ci 1 Distance to nearest: We --- Well - ---`-------------.- ---------------Foundation -------------------- Prop. Line ---------:------_-_. I I :rJ ; 3 f REPAIR/ADDITION(Prev. Sanitation Permit# '.____.:! --- --------------- ---_---_ Date __-___--__________. -------------- # ( Septic Tank (Specify Requirements) ------------.'--------------':_ f ---------------------- ---------------------------- ments)Field (Specify Require ------- la?__T = -- -�--f --`- =------if---_W--n------- ----- : I < [Draw existing ,bnd required addition on,reverse side) i 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,Jodquin 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 subjeo to orkmun's ompensation laws-of California." 1' , Signed --- -ar-- t------------ ' i - ---- -- - �---------------------- Owner 1 ' ( I ' BY -- ----- ----------- -------------------- (If other than owner) In e3 FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __.. ---------- = -----------'----. DATE -- BUILDING PERMIT ISSUED -------------------------------------- -------DATE ADDA1_ IT10N _COMMENTS A, - -- '--------------- ._. -------------- --- ------------------------------------------------------------ -------- ------------------------------------------------------------------ -- - - ----- -----=------ ------------------- --- Z---- Final Inspection b _______. __' , SAN JOAQUIN LOCAL HEALTH DISTRICT CZ 13 E. H. 9 1-'68 Rev. 5M