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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ '----- --------'----------�---------- Permit No. ---------=-------------- (Complete in Triplicate) p Date Issued -�_�_'k:.�. ---- _�/- -- -------------- 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 Yi ..c?mpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-Y,2- ''----- - "' W—-- -------------- � - ----- CENSUS TRACT _S y 7 Owner's Name A - - - -------------- --------------------------------------------------------Phone -------------------------- --------- Address --------A_,2'--Q----- y� 't" l '------------------------------- City -_46 '' t------------------------------------------- --------- Contractor's Name ---/.� err`t`--------------------------------------------------------- License # Phone Installat�n will serve: Residence ®Apartment Housef] Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:--- ------- Number of bedrooms __3______Garbage Grinder __________ Lot Size _ Q---------------------------------- Water Supply: Public System and name -------------------------------------- ---------------------------------------•--------------------------- ----Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan,] Adobe jal 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,) 1% PACKAGE TREATMENT [ ] SEPTICTANK Size__�_Y"I'�f-- ---------------------- Liquid Depth ..�_____.-_---___---_. W Capacity -__ ____ Typ _s—Iw _ Material____;:__,_ ___ No. Compartments _ -_................ Distance to nearest: Well ----S__0________________________Foundation -- ----------------- Prop. Line -C............... LEACHING LINE X No. of Lines ____o --------------- Length of each line____#-0-0 Total Length ................ 'D' Box _ ___ Type Filter Material _, --------Depth Filter Material __t�_ _____________________________________ Distance to nearest: Well *------------- Foundation 1__D_______________ Property Line _'}___------------------ SEEPAGE PIT Depth .__1�4-'______ Diameter __ _ �' Number __.-y-__.______________ Rock Filled Yes No 0 QQ / Water Table Depth 1-- ------------------------------Rock Size __ '`2-----�------------- Distance to nearest: Well -147-----------------------------Foundation /0------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------------------- ----------•--------...--------------------------- 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 becom ublect to Werk 's Con p? sati.on laws of California." Signed ---� =I 1- �G�' Q`rJ Owner By ---------- --------v----------------------------------------------------------------------------- Title ------------------------ ------------------------------------------ � (If other than owner) FOR DEPARTMENT USE ONLY One- APPLICATION ACCEPTED BY f"`' =tom c. r�!7` ----------------------------------- DATE _ft BUILDING PERMIT ISSUED -------------------------- -- ---------- _-. ------------------------------ 7 ---------------------DATE ----------------------------------------- ADDITIONAL COMMENTS ---- ------� ----�J------ ' ��-- - ---------- - ---------------------------------------------------------- ------ -------------------------------------------------------------------------------------------------- ------------------------------------------------- ------------------------------------------------------------------------ -- --------------------------------- /f� = Final Inspection by: --'r'� - ---------------------------------- Date '/ � y SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M