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FOR OFFICE USE: A �� NAPPLICATION FOR SANITATION PERMIT - J -y-�y----- (� Permit No. (Complete in Triplicate) __-...__---___--_--_-_------_-_---_-------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to the work herein described. This application is made in compliance with County Ordinance No. 549 oz4fiP469stall is ing Rules and Regulations: // _ f JOB ADDRESS/LOCATION ___ _�- __�� _____ `__�_�r �0-�C SU; q q Owner's Name ---------e - --- --- -----------Phone - Address ------ --- ,•'� 'irrS"d =-L� " P' `1X �CitY '' Contractor's Name/,, -rx-------------------------------------- ----------------------------License # ------------------------ Phone ----------------------------•- Installation will serve: Residence 0?Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- p Number of living units:----, Number of bedrooms J--------Garbage Grinder o4�-__ Lot Size . _ --_/-_-- (� Water Supply: Public System and name ------------------------------------------ ---------------------- -----------------------------------------Private' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan (V Adobe ❑ Fill Material _ 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 tank or seepage pit permitted if public sewer is available within 200 feet,) e PACKAGE TREATMENT [ ] SEPTIC TANK4 Size_ _____._ ------------ Liquid Depth _. ____ _----------- Capacity �a- Type � '�*_�__`�Materia �r�' o. Compartments '" ` Foundation ___/___-_'__ _ --__. Pro __9CJ Distance to nearest: Well __��_____________________ _ C! _ _ p. Line ______________ LEACHING LINE ) No. of Lines __ ___________. __ Length of each line/oo_&_�_"V?iTotal Length ________________ p r� 'D' Box�_---- Type Filter Material� _.__c _ _____-_Depth Filter Material ._ _<__._.___-_.-_--__________________ Distance to nearest: Well -4Yn--__.________ Foundation _____________ Property Line jk�7___------------- SEEPAGE PIT ( Depth ----Z-6 Diameter ----- Number ___ ----------- ------- Rock Filled YesEr No,,o e�h �. Water Table Depth ---A�t7---------------------------------Rock Size -- -----�- ------------------- Distance to nearest: Well ____`d_ _______________________-Foundation --- ----------- 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 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 as to become su ject to Workman's Compensation laws of California." Signed --i` ------ ------------------------------ Owner ----------------- - - -- BY --------------------------------------------------------------------------------- --------- Title -------------------------------------- -- ---------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- -- - d---.---------------------.---------- ------. DATE ---.--(I� -�^c ---_7_. -.---- BUILDING PERMIT ISSUED ___ _- DATE ._________. ADDITIONAL COMMENTS __ ` � a _7 ___..__. ._ --------- ----------------------------- ----------------------------------- >°�' f�. %- --------- --------------------------------- ------------------------------------- ----------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ - -- ------------- 1 - FinalInspection b --------------- ----------------------------------------- ---------------------Date ------ SAN ----SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M