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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT "` - Permit No. O_� ��. (Complete in Triplicate) Date Issued --:____ _ ___________________________________________________ This Permit Expires 1 Year From 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 iin compliance ith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__._ --__ � �1 �'--�__ _-CENSUS TRACT ________ Owner's Name ----------- --- --- ------- --------------------------------- --------------- ---Phone ---e_157 31/4------- _ ________________ _ ------------------ City ___ ____ _________ -----------------------f _...........................` ________e____ Contractor's Name __--_______- __ --------- License. #1_60 JL____ Phoni -%�_&0.-!---- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ / Motel F-1Other ------------------------------------------- Number of living units:----I______ 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 fl 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,) I �i PACKAGE TREATMENT [ ] SEPTIC TANK' size--------- ___l.�________.__________ Liquid Depth __S�_____________ Capacity 12WO___,__ Type _ _________ _______ Material___L� No. Compartments ----- ......... Distance to nearest: Well -----/&V- t _____________Foundation ---------------------- Prop. Line ---------------------- ,,11 LEACHING LINE No. of Lines Length of each line______�_�____-___--- Total Length --- d._�___._... 'D' Box _:_1/___ Type Filter Material 4tz------Depth Filter Material -----/-,e__r...........................� Distance to nearest: Well __ ------ Foundation ----/0--*' ____ Property Line ________._-_--__._-___ SEEPAGE PIT [ j Depth _--______ Diameter ________________ Number _________________:________ Rock Filled Yes '❑ No i❑ Water Table Depth -------------------------- ---------------------Rock Size -------------------------------- Distance--to nearest: Well ________________________------ ----Foundation -------------------- Prop. Line ...................... REP! iM/ADDITION(Prev. Sanitation Permit # __.____.-__ Date _______________:____.---_---______) ----------------- --- 'Septic Tank (Specify Requirements) ----------------------- /r' ------ Disposal Field (Specify Requirements) --_______-__ _________________ __-__________ --------------------------------------------------------- ----------- ------------------------------------------------ ---------------- --------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- --------- (Draw existing and required addition on reverse side) N 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 ` Title ------ -�------------------ ---------------------------- --- ---- (If other n owner) FOR DEPARTMENT NL APPLICATION ACCEPTED BY ---------------------------------------- -- - - ----- DATE -----l�- 0-2P----------------- BUILDING PERMIT ISSUED .-------------------------------------------- ----- ---- ---------DATE ADDITIONAL COMMENTS ---------------------------------------------- - ------- ----------------------- ------------ ----------------------------------------- -------------------------------------------------------------------------------- --- - ------- ------------------- --------------------------------- --------------------------------------------------- ------------------------------------------------------------------ Final Inspection b ' 7 ----------------- p Y - f .� Date ----- ------------ ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M