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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) �� G 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: c^ /7 ,� 1 - JOB ADDRESS/LOCATION . --- ------- ----- ----------------- f ------------------------------CENSUS TRACT -------------- --------.•- _17' _ - � `, L� -v tt Yom, 3 Owner's Name - -----�<-�c<---_ =fin ---- � ----------- ------------------------------------ Address ----- - --------------------- Address ___ _ _ Contractor's Name -------------- &f ---t/ art r 5--- _..License # _ -----V!J------- Phone1-- Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court ;❑ Motel Other --- .� Number of livingunits:____ -__ Number of bedrooms/_t�'_`�_" ?Garbage Grinder -___ Lot Size _ ___ '-� �`'-e� L ---- Water Supply: Public System and name -------- ''GSC -G �` ----------------•-----•------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ 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, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewers available within 200 feet,) r PACKAGE TREATMENT SEPTIC TANKX Size_ _ J ` ` ( ] �; y��-� `�-I-�------------ Liquid Depth ---1------------------- „ ;1 Material _L C%__ No. Compartments ___��___ % Capacity� Cr�`° Type - -- Distance to nearest: Well ___ )"_-ALE--------------Foundation _1_41____________ Prop. Line LEACHING LINE No. of Lines __ Length of each li rLength � r - - 9 �. � Total Le//ngth _ <--''------------------ 'D' Box ------------ Type Filter Material (4-e- Depth Filter Material ---l ---------------------------------- Distance _ _ Distance to nearest: Well l ? Foundation _ // _______ Property Line SEEPAGE PIT Depth _ ----- Diameter _c. c _�,__ Number ________1__.._-_-_____ Rock Filled Yes No i❑ Water Table Depth -----------L --------------------- --------Rock Size d-_--__-_______ Distance to nearest: Well � _________________Foundation _/_e�---------- Prop. Line _��z__r_ 4.-..?.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (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 performan of the work for which this permit is issued, I shall not employ any person in such manner as to bec subject to prk n'�Coryf � ption tows of California." 1,/ Signed _ _ .�-�-- ��. �-- �-� _ _--�_ , 4-- Owner By ------- - --- ------------ �-` - - `---------------------- Title -------------------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- -- K-- ----------- --------------------------------------------------. DATE •��""2� '� --------- BUILDINGPERMIT ISSUED -----------------------------------------------------------------------------------------------------DATE --------------------------------------- ADDITIONAL COMMENTS - - - -------------------- ----------------------------------- --------------------------------------------------------------------------- --------------------------------------- ----------------------------- ------------------------------- - --- ----------------------- - - Final Inspection by: ----------- ------�-- .-�.--_-C�/ - Date ------------------------- - ------ -- ---- ------- ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M