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t `FOR OFFICE USE: �G APPLICATION FOR SANITATION PERMIT _ J� m Permit No. ---�-------------- (Complete in Triplicate) ° Date.'lssuecl f This Permit Expires 1 Year From Date Issued y, 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: -------------------------- I JOB ADDRESS/LOCATION _ - CENSUS TRACT - --------- ----------- Owner's Name t � - ' Phone -----------J ---------------------- ? ccs ' Address �,7 *: = Cty t Contractors Name ---- --• F ---------`----- -License # _ _ Phone ._ Installation will serve: Residence Apartment House,[] Comme rcial:❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Nurriber of living'units:-.--/---- Number of bedrooms __sZ------Garbage Grinder _/ -- Lot Size _ -_ ---- ------ Water Supply: Public System and name ------------------------------ --------- -- - -------- -----------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay-E] Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe = Fill Material ------------ If yes,type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etcmust be placed on reverse side.) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 240 feet,} W PACKAGE TREATMENT [ ] SEPTIC TANK'[ 7 Size------------------------ -------- ------------ Liquid Depth --------------------------- I Capacity ---- --------- Type -------------------- Material--------- ------------ No. Compartments-- Distance to nearest: Well ---Len Length --------------------Foundation --------------- ------ Prop—Line ---------------------- ----------- LEACHING --------------------- LEACHING LINE [ ] No. of Lines ----- 7- -------- g ofeach line--..-: ------- ._ Total Le t �---------------- ' 'D' Box; %,� -- Type • ter Material,/./�1 Dre3 Filter Material _ ----f J r Prop rty Line tl�---------- Foundati Distance to nearest: el -' ----------------- SEEPAGE PIT [ ] Depth --- Diameter Number ----_---_._______-__------ Rock Filled Yes [] No WaterTable Depth ---------------------------------------- -------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------- ----Foundation -------------------- Prop. Line -------. ------------ REPAIR/ADDITION(Prev.-Sanitation Permit# -----------------------------------=-------- Date ------------------•---------------) Septic Tank (Specify Requirements) ------------ ----------------- - - ;--- -------` ------ ------------------------------------------ Disposal Field (Specify Requirements) -- --- ----------= ----------------------------------------- ---m----------------------- F 4 --- --------------------------------------------- (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 H.alth District, H m owner or licen- sed agents signature certifies the following: -" certify that in the performance of the work for which this permit is issued, I shall not employ any person to such manner as to become subject to Workman's Compensation laws of California." # �- Signed -------------- ... ��.+ wner s BY --------- ----------------------- _- _ Titl .. i (if other th wner) t r j ,. FOR DEPARTMENT USE ONLY F �.� = DATE __ fy -- •--- `-LAPPLICATION ACCEPTED BY __1______ - BUILDING PERMIT ISSUED = ------------------------------ --------- ` _DATE - { ----------- ,,'ADDITIONAL COMMENTS ------------------------ i `, `�_ s_ -- l------------- ----------------- • N _ 11 --------------------------------------------------------- L } ___________________S._____.___--- _____._--___-_ -"" 4! __ _________________.____________---.-__.____----_________.__------___ _ _ __ _ ---------- ------------------------- :_______ Final Inspection b Date A SAN .JOAQUIN LOCAL H;E=ALTH DISTRICT E. H. 9 1•'68 Rev. 5M wad