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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT 4 � --------------------------=------------------------------ Permit No: 1 (Complete in Triplicate) ------------------------- ------------- r x. Date Issued�__a This Permit Expires 1 Year From Date Issued i 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. 5A9 and existing Rules and Regulations: JOB f- 'G'-1 jc z_z_j /__ K--------ta r- 1�`'-- - ------CENSUS TRACT ADDRESS/LOCATiO - - Owner's Name -----VA---- ------- #' N---------------------------------------- `-------------Phone Address ------ �' �z -------fes City i , Contractor's Name --- -.r_-_.tf /'�-_ _/_�K ,---------------------------------=--------License #oz _} _ Phone - �-- - - Installation will serve: Residence [ Apartment House❑ Commercial ❑Trailer Court :❑. t Motel,❑ Other - ------------- ------ I Number of living units:___ _:__ Number of bedrooms ___•__.Garbage Grinder ------------ Lot Size �° name ------------------------------- ------------------------------ ---- --_------------------ ------ ----- Water Supply: Public System and Private - ❑ :. ,.. -� _ Character of soil to a depth of 3 feet:., Sand.`�^..Si.If.❑-„.,,,,:Clary„.❑:. Pea#„�...:Saridy;Loam ❑ Clay Loom El Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plo 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 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-----I--------- -------------------- ---------- Liquid .Depth -:------------------------ ►' Capacity . '•'�,'"..TYpe” -- Material------------------- -- No. Compartments ------- Distance to (earesfi: Well--- �''--------------------------- -- � Foundation ---------------------- Prop. Line -----_-_--_--_-------- �1 LEACHING LINE [ ] No. of Lines t------------------------ ength of each line----------------- --------- Total Length -------_-------------------- !r ` 'D' Box --- --_- --- Type Filter aterial --------------------Depth Filt r Material ------------------------------•---------•- � "4';j't ` Distance�t o nearest; Well ---- ---------------- -- Foundation --------- -------------- Property Line. ------------------------ G1 i SEEPAGE PIT [ ] Depth ------------------�,,-Diamet i•�--------------- Number ------------ _--_---------- Rock Filled yes © No ❑ Water Table Depth - ---------- -----------------------------------Rock Size --------------------------- Distance to nearest: Well ---- -----------------------------------Foundati n -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ------ --- _ Date ----- ---------------------------) Septic Tank (Specify Requirements) ---------- -------- ------------- -- - -------------- - -------•----------------------------------------------------------. -- ---- -•--- Disposal Field {Specify^--Requirements) -----------14 -----------S�----------1= f--------------�- - ---c- ------ �------- '� �7 - - --------- / ! ..----- ------------ ..-- . -: - --- -- (Draw existing and required ad i --------------- -------------------------------- ----------------------------------------------------------- -------------------------------------------------------- dition on reverse side) 1 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, I shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California.” c Signed -------- --- Owner --- ------------------- -------------------------- �� ------------------------- Title -------------- --------------- - ------ ------ (If other than owner) = FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. i-- - ��- --------------- � �_'7C�----- t�� ------------------ --------•-------- ----------------� DATE --- - - • - BUILDING PERMIT ISSUED ----------------------- DATE - ---------- ADDITIONAL COMMENTS - -----------------------------------------=--------------------------- --- -----------a ------------------------------ -- - -- ------------ -------------------- '- ------------------------------- ------------------ ------------------- --------------------------------------- --------------------------------------- ------------------------------- ----- ---------- • --- ------------- --- -- -- -- - = ---- - ---- - -- Finallnspection Date "� SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M