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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT z Permit No. - / �------ (Complete in TdPlicate)ON ; - x Date Issued5_aq--7_._ --------------------------------------------------------- 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: + 7 �, � CENSUS TRACT ------------- ------ JOB ADDRESS/LOCATIO -__-� - --------�s _�kJ� ' 1 Owner's Name - Phone �^ Address : � �1� --- ----- -----'=----------- -------- City ---------------------- --- License #tZ_4r7/r--57Phone Contractor's Name -- -------- F-1 ----_ - 011� - -- ------ ------- ----- ------ --- ----- - - Installation will serve: Residence Apartment ouse,❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- F r Number of,.living units:---_f-- Number of bedrooms __..._Garbage Grinderl�_ V_ Lot Size Water Supply: Public System and name ------ ------------- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt F] Clay ❑ Peat[:1Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe Fill Material ------------ If yes,rtype ----------------- - L4 1 a W (Plot plan, showing `size of lot; location of'system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:I!--(No septi0ank_br seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK: ' Size.- '-_l - ---------- Liquid Depth __ Capacity/rsgd-5 r6:_ ype M'aterial____64r, , No. Compartments -~____-___-- Distpnce to nearest: Well -/ __�� ---Foundation _._Gl --r------ Prop. line JJAPO r N LEACHING LINE � No' of Lines ___.__/__------------- Length of each line_- d----.------ Total Length ,__ -----_---- , �/� i 'D' Box _,_.l_d Type Filter Material _-0__ __Depth Filter Material -----��- el -------------------------- Well ---------------f--__-- t ---------- Distance to nearest: Well - �-_G -Foundation ___ Q_______.__ Property Line ----- ____..:_.__. SEEPAGE PIT # Depth ---'Ills— __ Diameter •___ -r"Number ___ _____ ___________��ock Fllled Yes, No 0 Water Table Depth------- •------ •----Rock Size -� ------------- F T Distance to nearest: Well a__ -------Foundation ---e-A--------- Prop. Line ------%.�.....••^--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----_-.-------.------------------) Septic Tank.(Specify Requirements) ------------------- ---- ------------------------------------------ - -------------------------------------- ,•---------------------------- -� Disposal 'Field (Specify Requirements) ---------- -- ---- -------------------------------------------------------------•--------------- - ---- - ------- -- ------- ------------------ ---------------------------------------------------------------------------------------------------------------------------------------- (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 Son 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: t "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner f as to become subject to Workman's Compensation laws of California." Signed -------------------- ----- ---------- Owner - - ------------------ Title 1 4' (If other than owner) FOR DEPARTMENT USE ONLY �--------------------- -- ---------------- . DATE _. __' ._ l------------------ DATE :------------- APPLICATION ACCEPTED BY .__..._ ____ - --------------- -- BUILDING PERMIT ISSUED ----- --------------------------------------- DATE ADDITIONALCOMMENTS ------ ----------------- -------------------------------------------------------------- --------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- ------------ ----------------------------------- 1 - f -------------------------------- -- ------ -- ---------------------------------------------------------------------------------------------------------------- 'Final Inspection by: �11-�--�3t-�--0'�R -- ------------------- ----------------------�---- ------------------ -----------,Date .�_-�_�_`f-j �-------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M