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FOR OFFICE USE: -- ____________________ APPLICATION FOR-SANITATION PERMIT —1 ---- ------- Permit No. ------`- `-- -- y (Complete in Triplicate) Date Issued _7""_Zy -------- ------4 ._ -- ----------------------- 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC'ATION _/_!V$/— _2.6___-__c _--.��'G'tk . -. _CENSUS TRACT ---------------_---------- Owner's -- -- --------- -Owner's Name - -i-------------------------------- - -- -- ----Phone .(. ------ Address --------------------------------- ----------------------------------------------------- ---------- --. City - r_ _, ,-- ----------------------------------- Contractor's Name __ - 't---- ----.',d"'_�=��--f,.�-�------------------- --------License --- Phone - Installation will serve: Residence{Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:____'____ Number of bedrooms -___....Garbage Grinder _____ Lot Size ,�C -r�.'_ _________________ Water Supply: Public System and name ------------------ -----------•-------------------------------------------------------------------------------Privatex Character of soil to a depth of 3 feet- Sand Silt F1 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe '❑ 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 orAeepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC-TANK{ ] Size___ ____________ Liquid Depth ----------------- -------- Capacity -L z'L__,__ Type _ '_ -__ Material__ _« : No. Compartments .....�............ Distance to nearest: Well ------- e_-----------------___Foundation ------ _.............. Prop. Line ---:!�n.............. LEACHING LINE [ ] No. of Lines - �-------------- Length of each line_____ '____ Total Length --/ _--__ _----- D' Sox �, Type Filter Material J__ ,.______-Depth Filter Material _____ ______________________________ Distance to nearest: Well _______� ____-_-__ Foundation -----.__A____---------- Property Line ._- ............. SEEPAGE PIT [ j Depth --- -------- Diameter _ '___ Number __-_______�-__-__-___ Rock Filled Yes.j No 0 WaterTable Depth -=----------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ____--__________-____-___.._______) Septic Tank (Specify Requirements) ------- --------------------------------------------------------------------•---------------------------------,._----------- ............... Disposal Field (Specify Requirements) ---------- ------------------- --------- ------------------------- - -------- ----- - --- --------------- -------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------=------------------------ ------------------------------------------ - -----------------------------------------------------------I--------------------------------------------------------------------------------------------- (Draw - ------------------------------------------------------------------------------------------------------------------------------------------------- (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 iF+%� = --- Title -------------------------------------------------------------------- =--- --- - --------------------------------------------------- (If other t an o r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- -- ------ -- ------------------------------------- -------------------- DATE ----q'_�°��1 ----------------- BUILDING PERMIT ISSUED --- N-----------------------------------------------------------------------------------------------DATE ----------------- ---------------DATE ------------ --- ADDITIONALCOMMENTS -------------------------------------------- -------------------- --------------------------------------------------------------- ------ --------------------------------------------------'------------------------------------------------------------------ ----------------------------------------------------------------------- ----- ----------- -----------------------------=°------------------ --------------- --------------------------------------------------------------------------------------------------------------------- -- --------------------------------------------------------------- -------------------------------------------------- -- Final Inspection by: ---------_---------------•----Date --------------------------- a SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M