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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -�-�-�/-�-----------'--------•---�--'---�- ' (Complete in Triplicate) Permit No. _3-ki_q_3 7 ----------------------- 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/LOCATION �� - - L.� -� -----CENSUS TRACT ---------------------- Owner's Name --o-- �s—)'1 ----------------------------- ---------------Phone Address ---------4-- - j ± _ __. Cityeaa Contractor's Name � :.�` _ ./C,Lkicense # _`�"L�d`9444 �__ Phone _-7 � Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court !❑ Motel ❑Other ------ Number of living units:-----1------ Number of bedrooms ---,.Z_---Garbage Grinder __________ Lot Size - CJ_ i 4 __.._..._.. Water Supply: Public System and name --------------------------------- ------------------------------------------Private ] Character of soil to a depth of 3 feet: Sand'❑ Silt F71 Clay Q Peat E_ Sandy Loam ❑ Clay Loam E] 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.) `n NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size------------------------------------------------- Liquid Depth ______--_._-_----_-...__ Capacity ------------------- Type -------------------- Material.-------------------- No. Compartments ------ ---- Distance to nearest: Well ------------------------------------Foundation --------- ------------ Prop. Line ---------------------- LEACHING _- .-_.- ._-____LEACHING LINE P6 No. of Lines -------/-------------- Length of each line--.--"- 16;-----._----_ Total Length / !- ............. 'D' Box ----/----- Type Filter Material ____----P�- _//__Depth Filter Material -------/-!5?-----........................ Distance to nearest: Well _ ------------- Foundation :. ----------- Property Line .......... SEEPAGE PIT [j(f Depth ----�vo _�__ Diameter} �-- Number ------------/-------- -_ Rock Filled Yes Z No Q Water Table Depth -------------� lef- --------------------------�11 Rock Size -------------,/----------•---- _ �-� Distance to nearest: Well ______,l` _ _______________________Foundation ---- -{-�------- Prop. Line -----.....J_._-_... REPAIR DDITIO Prev. Sanitation Permit# -------------------------------------------- Date ---_-.----.__-_--________________-) Septic Tank (Specify Requirements) --------------------------------------------- �� Disposal Field (Specify Requirements) ---- ---- - ----�� --------J5-_ % G_ ______:____ --------------------------------------------------------------------------- "`" '-------'------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - _ - - - , .� Owner BY Title LSC (If other than owner) Fp ARTMENT USE ONLY APPLICATION ACCEPTED BY ---- / -- - ------------------------------------------------- DATE r ------ BUILDING PERMIT ISSUED / - - ---DATE ----- ------- ----------------------------- ADDITIONAL COMMENT --- ---- -- -------------- - f�,_-!y-_ ---- - --- --- _ ____________________________________ ____________ _ _ _ - - ___________________________ __________ _ -r--_-___- ___--_-_____--______--__-____--_____---__--_--__--_----_-_-_____-_--__-__-____-----____--_-____------_--__-_-___-_---_--_------___-_--_ Final Inspection by: ------ - --------------------------------------------------------------------------------Date ----- --d j; JOAQUIN LOCAL HEALTH DISTRICT c E. H. 9 1-'68 Rev. 5M