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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 6f- /vv - -70----------------- --------------- Permit No. -7U-�6(� (Complete in Triplicate) ----------------T._. -------------------------------------------------------- -----------______------_-------_------_------------------ 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 madeincomplian a with Count Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ©? �J �___ _ ______ ?-.e� --____._________________________CENSUS TRACT _.--__.__---..__-_--_ d L/ Owner's Name d_-- C..�✓- _ --- ------------Phone --I-_ _�-�=v --- Address -------------------- /7A4------�s----- `---- -- -------------------- City ---- ------------------------------------- Contractor's ---- ------- ---------------------Contractor's Name ------------------------License # _. ,�r- Phone _ -` 'g:'-fit Installation will serve: Residence5;iT'Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -----*---�------------------------- ------ Number of living units:___- Number of bedroo s -_c ------- Grinder _.---------- Lot Size Water Supply: Public System and name -----------------G _ ? __.------------------------_-----------------.-----------Private 11 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 sewer is available within 200 feet,) O PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth ___.------__.______-_-__- Capacity -------------------- Type -------------------- Material--------------------.- No. Compartments Distance to nearest: Well --__-___-________-_-___-_Foundation ---------------------- Prop. Line ______________--_-___ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line__________________________ Total Length ----------- ---_----------- 'D' Box _.---------- Type Filter Material --------------------Depth Filter Material ______--___-_._-___-.--__.--------__---:---- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -----------------.._--__ SEEPAGE PIT [ ] Depth -------------------- Diameter ____ _________ Number ----------------- Rock Filled Yes ❑ No 0 Water Table Depth ---------------------•------------- ------------Rock Size ------------------------------- Distance to nearest: Well __________________________________ ___Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ---------_.--------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------------ - -- -------------------------------------------------- -- _ -- - _ -- -------- Disposal .Field (Specify Requirements) ___� _ ________�®__,ri, '�. --------------------- . __ . . -- -------- ------------------------- -------------- - ----- -------------- ------ --- ---- --- - - ---- - ----- -- _ �m �.S ! - - -- -- - --- -- - ------------------------- --------- (Draw existing arYd 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: "1 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 beco sub'ect to Wanpensation 1 of California." � J7 Signed - - ""��_--- Owner By ----- --- - l a ' Title ' ---- --------- - --- - --------- ---- ------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I -------- - - - - ------------------------------------------ DATE -7--_,-)_��------- Q------ BUILDING PERMIT ISSUED -------------------------------- -----------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ 4 - - - - ---------- ---------- ---- - Final Inspection by: ------------------------------------------------Date ------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M