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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------ -------- ------ -- - Permit No. (Complete in Triplicate) ----------- �r .;� 70 Date Issued ___�___ �__. _--------------__-------------- 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 compliant with�County Ordinp7ce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC01 - F '""'`"` CENSUS TRACT _____ __________________Owner's Name " - ----------- - Phone . . ,� Addres � '" -. --�; r„f 'C � �1 <;-------. City f '��,3 s�------------------------------------------------ s --� _' l S1 Contractors Name ` JCt� � C to.� - --.�j4 F =`-p _ -?-__,___License # - -- `f__. Phone Installation will serve: Residence ❑Apartment I-�6use❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------_ _ Number of living units:----I------- Number of bedrooms _7-_`____Garbage Grinder A`er-___ Lot Size ___ ----------- Water - --____Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private 56 Character of soil to a depth of 3 feet: Sand❑ 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,) �rs PACKAGE TREATMENT [ ] SEPTIC TANK[ 4 ,.- ,Size___ ` ��'� ------------ Liquid Depth _._ '- __--------- t.�.�" -- ----- ----- Capacity _! _C'�______ Type ___�±_-- {± __ Material_ _:�_ _t_t c.,- No. Compartments .._ .�"'___..:__-- Distance to nearest: Well ___T-..�_-______-__-__._-----_Foundation _l_ ----------- Prop. Line _____________ ______ LEACHING LINE ( No. of Lines ----- --------------- Length of each line--__-/'°___________ Total Length - _ 'D' Box ----I----- Type Filter Material _ _-_-_Depth Filter Material -----`_ ------------------------------" Distance to nearest: Well _ — Foundation `___-______ Property Line __/_15______________ 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 -___.._.-_-__-____._--------------) Septic Tank (Specify Requirements) -------------------------------- --•----------------------------- Disposal Field (Specify Requirements) ---------------------------------------------------------- --------------------------- -------------------- --------------- -------------------------------- -------------------- -------------------------_------------------------------- ---------------------------------------------------------------- - (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 ,�� t in the performa�e of the work for-which this permit is issued, I shall not employ any person in such manner as to become ubject to or n o�pensatia laws of California." -_ Signed `{-G�-�i- t r gY - 114 ---------77eliii1:� f 4C� - ----------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY .. L' 7 APPLICATION ACCEPTED BY -------- ----------------------------------------- „ . DATE - - -`"4 BUILDING PERMIT ISSUED --------------------------------------------------- - -'-------- --------------DATE ADDITIONAL COMMENTS ------------------------------------------------------5 'f - - - - - -------------- ---------------- ----------------------------------------------------------------------------------------------- ---------------- - - -----------`.--------------------------------- --------------- -------------- Final Inspection by: - �/ _Date / 0 - SAN JOAQUIN LOCAL HEALTH DISTRTCT E. H. 9 1-'66 Rev. 5M