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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - - Permit No. _ �"-_3--- _- .� .,► (Complete in Triplicate) - ------ ----------- - --------- ---------- ---- 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: JOB ADDRESS/LOCATION .______., _ ��_E�__ �__ 1�. �Y----- 1 - ------CENSUS TRACT --------------._-.-_-.____ Owner's Name ----- -•------/�_ G11 ----------------------•------------------- ---------Phone Address y� _ e�or , r--------------------------- City Contractor's Name ---- 174 -------------------------------------------------------------.License # ------------------------ Phone --------------------_------- Installation will serve: Residence ❑Apartment House f-1 Commercial ❑Trailer Court 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 El""'Silt❑ 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 or seepage pit permitted if public sewer is available within 200 feet,) �� PACKAGE TREATMENT [ ] SEPTIC TANK fLI _ " Size/ __ ___X f Q_---- _____.____ Liquid Depth _ ------------ Capacity _ _ TypeK__'' o_— t Material_64W_Ceo�fc-No. Compartments ...;:7i_......... Q .. Distance to nearest: Well -.____sS_0-_________________Foundation ___.__--------------- Prop. Line,�h4ti!Y_..___ LEACHING LINE [1.? 'No. of Lines "__�-.___-_-__ Length of each line___ ------------ Total Length ,__-t�_-"70---__- 'D' Box _ __ Type Filter MateriaJ,.��_X4 �"4epth Filter Material ____- ----------------- --- Distance to nearest: Well ___.. C)______-__ Foundation .____,4 ----- -_ Property Line -�M_---- . _ SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No :[3 Water Table Depth ---------------------------- -------------------Rock Size -------------------------------- Distance to'nearest: Well ________________________________________Foundation -------------------- Prop. Line _..........___-_------ REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------- -----------------,.--------------------------- Disposal Field (Specify..Requirements) ---------------------------------------------------------------------------------------------------------------------- --------------- ------------------------- ---------------------------------- ----------------------------------- --------------------------------------------------------------------------------------------------------- ------------------------------------- -------------------------------------------- - ----------- ------------------------------------------------------------------------ (Draw existing and required addition on reverse side) 1 hereby certify that 1 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:f "I certify that in the performance of the work for which this permit is issued; l shall not employ any person in such manner as to becoTeobject to Work n' o pen ation laws of California." Signed ---- G z" f� Owner - ------------------ By ------- -- Title -------------- ------ ------- --------- ------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -7 ------ ----------------------------------- ------------- DATE -- X7_0-------- BUILDING PERMIT ISSUED ---- ------------------------------------------------------- _DATE-----------------•---------------•-- ------------------------------ ----------- ADDITIONALCOMMENTS --------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=------- Final ----- Final Inspection by: - ------ ------- ----------------------------- -------- ----- ---------- Date ------ /!� � UIN LOCAL HEALTH `-DISTRICT µ E. H. 9 1-'68 Rev. 5M