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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------- -------------- j� (Complete in Triplicate) Permit No. ___-_-- --------------- --__-___---_- 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: zwe - -CENSUS TRACT JOB ADDRESS/LOCATION .� =C�2� --- � Owner's Named ------ - Phone Address 1 _Q_ -------- -- ---- City " ` ° Contractor's Name _______ xt __�---- -��-- --License # - _ 3 �'Phone _______________-------_--- ------- _________ __ Installation will serve: Residence ❑Apartment House,❑ Commercial ❑Trailer Court i❑ Motel ❑Other ----- -- ---- - --- ��'?-} Number of living units------------- 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 LoamClay Loam Hardpan ❑ Adobe'F� 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 see ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ Size-s__X_fo____X•C -- _-__----_-_-- Liquid Depth ---�°_ _____________ A Capacity -r'_&_c_�_ Type 1�:�--- Material__' ,_!J ___ No. Compartments - ..------------- `t Distance to nearest: Well --------�t?C_�------------------F undation -------1_P__i_-_-____ Prop. Line ^�_-S_-____J_---____ LEACHING LINE [IT'" No. of Lines ------- _____________ Length of each line----------+`__t?--r-------- Total Length ___ `.v----•----.-- 'D' Box -_ ___ Type Filter Material ----S___1Z.-------Depth Filter Material ------ _____-_--_----------------- Distance to nearest: Well ------- ------ Foundation -------f_o_--___-____ Property Line ----------------- SEEPAGE PIT [ ] Depth ____---------- --- Diameter ---------------- Number ---------------------------- Rock Filled Yes '❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _-______--_---._.--- REPAIR/ADDITION(Prev. Sanitation Permit# ----------- -------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) --------------------------------------------------------------------- ------------------------• --------------------------- Disposal Field (Specify Requirements) = -�".------------,Q------------ G.. _ . 4 — Luce c .c am -' --.---�'- Y------�- ----------------------------------------- ---- / W (Draw existing and required addition on reverse side) I here y 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 ------------------ y,,.R` OL G 1 P BY ------------------------------- Title (If other than owner) 42 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE ---------- � BUILDINGPERMIT ISSUED --------------------------------------------------------------------------------------------------------DATE ------------ ----------------------------- ADDITIONALCOMMENTS ----------------------- - ----------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------- -- ---- -------------------------------------- ----------------- ---- ----------- -- ------- Final Inspection by: = �- --------•---------------------------------------------------Date - _ :- 7 --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M