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.r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . (Complete in Triplicate) 4 --- ----=------ - ---- This Permit Expires Date Issued - ._6�_�/�r• ------- ---------- ------- ----- - - Y Year From Date Issued I Application is hereby made to the San Joaquin Local health District for a per to construct and 'install the work herein described. This application 4macdle.' c rrpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .- �'--- - -------- ------------ --CENSUS TRACT ------------- ?(_--r Owner's Name - _IT e-�r�i— -------------------------------------------------------- --------------- -------------- --Phone r City - -----f �_ ,�[P- -------- ------=-------------------------------------- Address - T- --- •� ------------ , Contractor's Name --------- ----------- -- - ❑ ----- Phone ------------------- ---------- -- ---- - # --------- ----- - - - - - - License------------------------------ i Installation will serve: Residence Apartment House-❑ Commercial Trailer Court ',❑ Motel ❑Other -------------------------------------------- s------ a Number of living units:--/------ Number of bedrooms � Garbage Grinder ------------ Lot Size ----________.c Water Supply: Public System and name _____________ __ ___ Private'' [ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam, Clay Loom � b r 'k E �Ice Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type _ _-- I0Af {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 if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK!M Sizd---------------------------------------------- Liquid Depth --------------------------- capacity Type -------------------- Material---------------------- No. Compartments ------ ------- ------ PY -------- --------- YP rDistance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------- Length of each line---------------------------- Total Length ________------•------------ E LEACHING LI [ NUnes ---------------------.-- 'D' Box ------------ Type Filter Material ____________________Depth Filter Material --------------------.---------------------•- .! Distance to nearest: Well ------------------- Foundation ------------------------ Property Line -------------- ---------- ' �SEEPAGE PIT [ ] Depth _____ Diameter __________----- Number ,.__ � .................. Rock Filled Yes ❑ No Water Table Depth -------------- - Size___-_-____:Rock Siz -------------------------•------ 1 Distance to nearest: Well ------------------------ .Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ---------------------------- ---Septic Tank (Specify Requirements) -------- ------------------------------------------------------------I------------ --- -----------�----•------. 91 Disposal Field (Specify Requirements) �'� 1 �- - - - ----- - 7e---- 5" (Draw e� [Drraw existing and required addition on rrse side) C.u7 �-s�Ca.� 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, 1 shall not employ any person in such manner as to become subject to� -- Workkma(n,'s Compensation laws of California." Signed _ . .Gc C---H4,47��c Signed Owner By ---------------- ------------------------ Title -- -------.---- ----------------------------- ------------- ------------ (lf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --P f --------------------- DATE __�---------•--- -- ------ BUILDING PERMIT ISSUED -----1------------- -------- DATE .. - -- - ------ ----------"----- -=----------=----------------- ADDITIONAL COMMENTS -- ---------------------------------------------------------------44,7----- ------------------------ ------ -------------------------------------------------- ' ----------------------------------------- ------------------ ------•--------- ------------------------------------------------------------ --------- ------ - - - ----- - - - - ----- -- - Final Inspection b - - Date -- -- -------- ---- --- - --- ------- -- - -- ----- ----- P Y= SAN JOAQUIN LOCA HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M __