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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- ------ -- --- ---------- Permit No. -- -- (Complete in Triplicate) ? ✓ �1- 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 in compliance with cZu Ordinance No. 549 and;ex_isting Rules and Regulations: JOB ADDRESS/LOC TION �j�m0--[ ,�y----- - �� -CENSUS TRACT Owner's Name SC " - ------ Phone Address ----- 1740 G��s�✓ CitY Contractor's Name - - License# . ��. --- Phone Installation will serve: Residence partment House❑ Commercial []Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of living units:-------I---- Number of bedrooms -__-___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 21-*' Clay Loam ;❑ Hardpan ❑ Adobe,7 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) QQ PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size�``''�iX__7_./X-S-.._____-_,___________ Liquid Depth ._.�---_.---- ___________ Capacity - Type Materiae- - No. Compartments - Distance to neare t: Well -----------0----------------------Foundation __l__4____----------- Prop. Line _f____,___________ LEACHING LINE [*(/ No. of Linesr _s�`�a_ _________ Length of each line_____�a-___-----------__ Total Length __CP_3�©__ ____________ 'D' Box _ Type Filter Material __2---------Depth Filter Material .__J _____________ Distance to nearest: Well -__,,,.5o------------- Foundation _. sa---`-------- Property Line ________________________ SEEPAGE PIT [ ] Depth -------------------- Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth -----------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ------------------_---------------------Foundation -------------------- Prop. Line ----_--------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------_______) Septic Tank (Specify Requirements) ------------------- -------------------------------------------------------------- ----------------------------- --------------------------- Disposal ----- ------------- .._-------------------••------ DisposalField (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 performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject orkman's Compensation laws of California." Signed ---------------- - Owner BY - ----------------------------'------ - - ------ Titles (If other than owner) FOR DEPARTMENT USE ONLY C 1./ � APPLICATION ACCEPTED BY ------��._ 't.�'------Z--------------------------------------------------------- DATE7 0 --�"------ -------------------------- BUILDINGPERMIT ISSUED ------------ ----------- - ----------------------=------------.-DATE -------------_---------------- ----------- ADDITIONAL COMMENTS ---------------------------------------------------------------------- -------------------------------------------------------- ------------ - < �- - ------------------------ --- Final Inspection by: %` �` ----- ---- - - -------------------Date =--Z---------------- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1-'68 Rev. 5M