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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No. --------" --------------- (Complete in Triplicate) - --------=------------------ - Date Issued --------------------- "_r""1"�_"�.?� This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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/LO ION00 _`G_- - ,- '-- - - ` CENSUS TRACT _ l3 -230—! a Owner's Name -_ _ Phone Address ---- --- ----- . --- -- -- - -----. City 3 - ----- - � c . Contractor's Name ---- --- ----.License # _ Phone Installation will servd:j Residence Apartment House❑ Commercial :❑Trailer Court ;❑ � aSa Motel ❑ Other.---__- I- " Number of living units:_----_-_- Number of bedrooms �--_.---Garbage Grinder -------_. "" Lot Size -- ------- --------•----_-�----------- ` Water Supply: Public System and name ----------------------- -_ Private ] Character of soil to aidepth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑, _Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Material yw 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 flank or seepage pit I"permitted if public sewerlis available within 200 feet) PACKAGE TREATMENT [ ] SEPTIC TANK 11K, c==Size_ _ _ --__._ _��---�X 9Depth Capacity !-a`�V Type(1.W - Q =--Material .. _ _._ No. Compartments _ .........:.... Distance to nearest: Well --__--_-�p_ """__-------------Foundation ----LV?-_--"""""""" Prop. Line ...... LEACHING LINE [ No. of Lines ------- ------------ Length of each line---------?a_ "--------- Total Length a-.--------- 'D' Box ----I------ Type Filter Material .."_".Depth Filter Material ------/_1__J_1---------------------- Distance --------------------------Distance to nearest: Well ------.moo" _-_----_ Foundation -___--1_ ---(__"""""__" Property Line. S SEEPAGE PIT [ ] Depth "_ Diameter ---------------- Number ---------------------------- Rock Filled Yes 0 No �] Water Table Depth ----------- ---------- --•----Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .------_------_--- REPAIR/ADDITION(Prev. Sanitation Permit L# -------------------------------------------- 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 San Joaquin ' 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 ----------------------------------- nn Owner �-- BY --------------------- -J 6'�- � Title -- -- ---------------- ------------------ ----------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------- DATE X10--��-"' BUILDING PERMIT ISSUED ------------------------------- ------DATE -------------------------------------..!" ADDITIONAL COMMENTS --------------------------------------- ---------------------------------------------- ----------------------------------------------------------- - -- -------------------------------------------------------------------- ------------------------------- --- --- -------------------------- - Final Inspection by- ------------ j�` ------- Date _ `" SAN JOAQUIN LOCAL HEALTH DISTRICT . E. H. 9 1-'68 Rev. 5M