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FOR OFFICE USE: ' --- - APPLICATION FOR SANITATION PERMIT -------- ----------- (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 appl, tion is made in compIian a with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/1-01ATION y 0_ L. G/� OW, ei1t4u ----------------- ------------------CENSUS TRACT Owner's Name --- Ll E S ---------- ----------------- - ---- ------------------ --------------------- ,,� Phone Address ��. _ City ------------ - - ,,� ------------------------------------------- Installation - - - - ------------------------------- Contractor's Name ___ �L-�__ _ ------------------------- - ----- ------.License # ------------------ - - ------ 1 -__ Phone ------------------------------ Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ---- -------------------- Number of living units:,_________ Number of bedrooms _-- "'"Garbage Grinder ------------ Lot Size �> GCJ�,C Water Supply: Public System and name - ----------- _ Character of soil to a depth of 3 feet: Sand's Silt❑ Clay�DPeat Private ❑ ❑ Sandy Loam ❑ Clay Loam E] 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 t permitted if ublic sewer is available within 200 feet,) _ Pi PACKAGE TREATMENT � SEPTIC TANK P P p - (,C` ] ,!aZe ---- Liquid Depth -- 1 --------- Capacity ---- ------------- Type aterial No. Compartments �_ _----_ Distance to nearest: Well _ - ----�-- �� ----------Foundation / "-------- Prop. Line ------- LEACHING LINE G `;---------_ [ ] No. of Lines __________-._ -______ Length of ine________U-� '- - --- Totaall Length ----,6-?,'------------ D' Box _- I___-- Type Filter Material _ ach _______-.Depth Filte6 Mate�laf - _.J2�}( eJ b t --------- ----- _ Distance to nearest: Well _-__, _ _-:_ __- Foundation ___1�__�_-_--_____-- Property Line -_--- SEEPAGE PIT [ j Depth P -----________-_-- Diameter ---------------- Number ----------------------___-- Rock Filled Yes ❑ No � Water Table Depth -------------------------------- - -------Rock Size ----------------------•-----•--- Distance to nearest: Well __________-__- -----------.Foundation ----- -------------- Prop. Line ---------------.------ REPAIR/ADDITION(Prev. Sanitation Permit.# ___"-_.-____-_ ------------------------ Date ) Septic Tank (Specify Requirements) ------------------ Field (Specify Requirements) _-_,_----_" _ ---- ' 1 t,--- � --------------- -------------- (Draw existing and required addition on reverse side) ----------------------------------------------------- - I 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: "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�Wor�ls ompe satio of California." Signed __ f --- - Owner By - - - - - - - ------------------ Title - ---- ---------- (If other than owner) - - 'FOR DEPARTMENT 111CE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED _ ---------------- --- C' - - -----------. DATE ADDITIONAL COMMENTS DATE ---------------------------------- -------------- - -------------- -- -------- ---------- - - ----- - - ------- - -- ------------ -------------------------------------------------------------------------- Final Inspection b - - --- --- - ------------------------------------------------------------------------------- -- -- - ------ ----------------------------- y' - - � --------- ---- --------- --- --- ------ - - - ------- - -- ------ -------.Date _�Q��-3-- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M