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fir*$ OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------------------------------------------- - (Complete in Triplicate) Permit No.��__��_______ -_____-.___----___-_____________.________________ 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 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/LOCA A6--�-`f-6--- --- -----fid- ------CENSUS TRACT --------------------_-- Owner's Name . _____________^ __.Phone --- Address lZ`-- '`-- - - �-/ J City Contractor's Name ----- -------- - - ---- ----�--K.- --• _----.license # ff r3l�------ Phone ------------------------------ Installation will serve: Residence ' Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other -- ------------------------ Number of living units:________ Number of bedrooms __._Garbage Grinder ------------ Lot ----------- _______.... .- Water Supply: Public System and name ---------------------------------------- ------------------------------------------------------Private [ � Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat E] Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------ ----- If yes,type ---------------------------- (Plot ______________________-_(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) W NEW INSTALLATION: (No septic tank or see�fae pit permitted if public sewer is available within 200 feet,) �JJ //� r - PACKAGE TREATMENT [ ] SEPTIC TANK[ Size.____/"�'.�_�__ _ ------�__ _____ Liquid Depth ____ --------------------- Capacity _______ __.,_____ Capacity ---�_L c�._, _ Type _ �__ ° Material___- No. Compartments _�______.__. r istance to neares . Well ---------v`"-d r_______________Foundation -1/10---- Prop. Line _-,___1,97 :_.______ LEACHING LINE [ No. of Lines -----------/------.__ Length of each line-------- ________ Total Length ,_,l_�' ?_______________ 'D' Box V------ Type Filter Material _____sS___ -2--Depth Filter Material -----I-__f-_�__________________________ Distance to nearest: Well ------Sv_f------- Foundation .----/__Q------------ Property Line __ __ / ___...____ SEEPAGE PIT [p� Depth ----Z_S...... Diameter ---- Number ______Q2----------------- Rock Filled Yes No i❑ Water Table Depth ------------------- i-------- -----------Rock Size --------- Distance -_-----Distance to nearest: Well --------- --------- _-----------Foundation --- Prop. Line ...... ............. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) SepticTank (Specify Requirements) --------------------------------- --------------------t-----------------------------------------------------.._---------- --------------- Disposal Field (Specify Requirements) _._ -i Z' i� ------ ------ L©-lS-f e —�'- � =' '-z= 1 i X --------------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------------------------------,-�---------- -------------------- ------------------ -------- Owner ' BY C•- - Title = - a`------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._ ,, __'_ ° ----------------------------------------------------.---------- DATE __41 -' BUILDINGPERMIT ISSUED -----------------------------------------------------------------------_---------------------------------DATE ------------- ----------------------....... ADDITIONALCOMMENTS ---------- ------------------------------------------ ------------------------------------------------------------ ---------------- ------------ ------ - --------------------------------- - -- ---- ----- ----- --------------------------------------------------- _ - -- ---=------- Final Inspection by: _ ., �______ ° ' - - -Date ------------------------ __._ __'.. ... .......... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M