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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Off . --- /1�11-�------ r (Complete in Triplicate) Permit Permit No �7 �' //' , ------------------------- This Permit Expires 1 Year From Date Issued Date Issued -------------- 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: JOB ADDRESS/LOCATION . 0 '- ----- -- -- ------CENSUS TRACT --------------•-------- Owner's Name - ----.--Phone / / ....... Address --------------------------- --- --- - --- -- j7-1-------------- --- --------------_ City ------------------------------------ ----------/--�/----------------------+-�--- Contractor's Name ------------- ------ --- ----------------------0 -so-?LO--- ----'---.License # AtOSJ----- Phone _7_�6_-�Q.i-- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:---t------ Number of bedrooms --3-----Garbage Grinder -- -------- 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 ❑ Adobe Fill Material ------------ If yes,type ____________________________ LAI (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,) 0 PACKAGE TREATMENT [ ] SEPTIC TANK Size_____---------------------------------------- Liquid Depth -___--____-•-- ----- W Capacity tto-Q-------- Type _ Material-- No. Compartments -----.�-�----........ Distance to nearest: Well -__ d 6--------------------Foundation -./Q-r____-_•_ Prop. Line ------"'..--_.--.-. •v i LEACHING LINE [ ] No. of Lines ---------S-:7-------- Length of�yeach�line-------"7_.S ............ Total LengthV______________ 'D' Box ____✓_ Type Filter Material _j - ------_---Depth Filter Material _-__-�9_��.................---_._----_ Distance to nearest: Well ----'AG___.-------- Foundation /0- -------- Property Line ________________________ SEEPAGE PIT [ ] Depth _.___ __-_____ Diameter _ _______. Number ____-----y---------- Rock Filled Yes No 0 Vuater Table Depth -----------------------------.------------------Rock Size - Distance to nearest: Well -------/_�*----------------------Foundation __/_Q-_--.-----. 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 Diptrict. 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 subject to Workman's Compensation laws of California." Signed ----------------------------------- ------ ----------------------------- Owner By ------------------- /��lf - ---r--- ---- --' - - - ---------------------- Jitle (If other th caner) FOR DEPARTMENT USE ONLY 2 6 APPLICATION ACCEPTED BY----------- ---n- - - ------------------ ----------------------------- DATE ------------ BUILDING PERMIT ISSUED -------------- -------------- ----------------DATE ADDITIONALCOMMENTS --------------------------------------------------------- --------------------------------------------------------------------------------------------------- --------------- ------------------------------------------------------- ------------------- - - - - --- - t-----=------- Final Inspection b Date --_ ._ 6 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M