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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1Z....................... ....... . .. .... Psrmt No. ` Q IComplte in Triplicate) ......... .................... _ ....................................................... This Permit Expires t Year From Date Issued Date !sued ..� :1` 77 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 ..... .........CENSUS TRACT ......... .......'......... Owner's Name ....... '.....••..........................•--..............................---..........Phone Address - ........... ....... .....................................City ....5 Z��.- /`' / ... ...-_..-................._........... . Contractor's Name - .�j ', /r1�...,, .C�`�:.........License #� �'r ` .. Phoney:.. .. Installation will serve: Residence IX Apartment House 0 Commercial❑Traller Court 0 Motel❑Other........................................... Number of living units:-../....... Number of bedrooms .......Garbage Grinder P. Lot Size ,� x.L. .................. Water Supply: Public System and name .............................................................................................................Private Character of soil to a depth of 3 feet: Sand CI Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam ❑ Hardpan❑ Adobe J? Fill Material ............ If yes,type............... I........... (Plot plan, showing size of lot, location of system in relation to welts, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ l SEPTIC TANK£ j Size................................................ Liquid Depth ........................... ' Capacity --- -----------_ Type .................... Material....................... No. Compartments ......................6j 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 ........................ 17 N SEEPAGE PT E ) Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No i[I Water Table Depth ................................................Rock Size .................... . Distance to nearest: Well ........................................Foundation .................... Prop. Line ......................0 REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................) SepticTank (Specify Requirements) ...... ..............-_----......................................................` _ .................................................. Disposal Field (Specify Requirements) .............. .2 . .... 'i7, .�%• ..................•-•-•-•••.......-----..........................._ ------------------ ..................--.--............ .................................--•••••-•••.................................................................................. (Draw existing and required addition on reverse side) 1 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 lion- 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 became subject to Workman's Compensation laws of Callfornia." Signed .............. Vow=r),/. , Owner By ... ................................ ,� .------....._... -----_. Title _. . . 1 �. - (If other tho '�� , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. BUILDING PERMIT ISSUED ... ... .................... ......................................... .....---DATE --- ---------------...:.............. ADDITIONAL COMMENTS ---------- -----------•--•-•---............ -.... _... - .... •. ............ Final Inspection by: Date 1' -�� 1 ..__......� .... .. .. .................................................................... .................... ......- .......... ........ ............... + Edi 13 24 1-68 v, SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M