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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �S_ �� -- '+se?----= . . Permit No: - --- -- ----------- Date - ------------ ----------- (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 ismade i compliance with County Ordi549 and existing Rules and Regulations: E JOB ADDRESS/LOCATION .. - --------------------- --CENSUS TRACT Owner's Name /-------------- 1 ---------------------------------------------------------------Phone Address ----- '' 1-442R-4 ---- ("7 City19?V72,-� ------------------------- Contractor's Name ---. r _. G ----------------------------------------License #42A_'J Phone Installation will serve: Residence M Apartment House,❑ Commercial ❑Trailer Court 0 Motel ❑Other -------------------------------------------- G Number of living units:-/-------- Number of bedrooms __`___Garbage Grinder _________ Lot Size . _ __----__-_--_-----_ WaterSupply: Public System and name ------------------------------------"-----------------------------------------------------------------------,._Private w Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;K Hardpan ❑ Adobe'❑ Fill Material If yes, type ______________-._________ (Plot plan,-showing--size of-tot;location of—system—in to wel"Is, buildings, etc-'"niu'sT pa —ruvers-eedside.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-_`��'�'. '"!! ' `_ ------- Liquid Depth _- _.. ..... �Capacity/ --- ---- Type �_4�7Material---------------------- No. Compartments ---�( ------------ - Distance to nearest: Well ___��__' _ J Foundation /�� Prop. Line.40-0' I# _--------- LEACHING LINE [„] No. of Lines --�______ -______ Length of each line--- :J0-_---___.-_____ Total r Length 1643,_F............. 'D' Box --- Type,Filter Material Depth Filter Material -------------------t........:.... It p. SEEPAG leZ � i Distance to nearest:`Wel d -------------- Foundation h' ----------------- ........ __ Property Line ._ `�_.. .... }E PIT [ ] Depth _ p -- _ Diiameter �Xx? ___:Number -_ --__--. --- Rock Filled Yes Cys No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ........._............. H REPAIR/ADDITION(Prev. Sanitation Permit# ________________ t ` ---------------------------- Date -------------- Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- ------ ----------------------- -- Disposal Field (Specify Requirements) ____________ __ 3 $ I (Draw exi�sting�a:n requ 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 thelSan Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following:_ "1 certify that in the performance of the#work for which thi p rmit is issued, h.shall not employ any person in such manner as to become subject or a�spensationlaws of California:' } t :•. g I % . Si ned /- Owner i ) BY --------------------------------------------------------- I j �• -------- Title ------------` (If other than owner) I i $ FR&DEPARTMENT.,USE ONLY i n; APPLICATION ACCEPTED BY ---- -` ; I --II' - DATE ® `--------------------------------------------- _ _ ___ _ BUILDING PERMIT ISSUED _ ...- .. ,__ _ 1 DATE ADDITIONAL COMMENTS __/ �►9t.,. _. u,.�u..�Nt?�s_aC. e �,�d, �"' - __________________________________________________________________4_ - _ _. - j - - _ ._ ;- - ----------- ----- -- - -- --- -- --- --- - ---� .- Final Inspection by: ------:__ V -- - ---_. . - -- --- ?a '��----______ __ ___ __ - .Date . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,,