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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT , Permit No. (Complete in Tplicate) ri ------------ -J-0-------- ----------- 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: ' ' ---CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION ------ _� _m,--- _ �r►.� __ ,,_ At 50r--�i��La�� Owner's Name -----Phone ------------------------------------ � „�� ` {3 G� -----=------------ r �.� ------- Contractor's Address ----�'�--C�-U---._L�_c7_t:?��_1_t'� � --�-{------------------------ -•--• Cit �Q�- � _1 - v'-- �,-fie-- - -� -- � ----- . Contractor's Name .- -I- -C.I �fCa ----- -----License # __ ��`. -�-- Phone 2 -•--- Installation will serve: Residence X Apartment House❑ Commercial :❑Trailet Court ',❑ Motel ❑ Other ------- -------------------------- Number of living units:.....1----- Number of bedrooms _____Garbage Grinder ------------ Lot Size ___/C/ _Ct_L'reS------------ Water Supply: Public System and name -------------------------------------------------------------- --------•----------------•------ --------------.Private (� f Character of soil to a depth of 3 feet: Sand'[Z Silt❑ Clay .❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ___________ If yes, type ---------------------------- Y (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be;;,plac6d on reverse side.) ►i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) E j PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-------------------------------------------- --- Liquid Depth------------I-------------- Capacity --------------------- Type -------------------- Material---------------------- No. Compartments ---------------------- Distance to nearest: Well ------------------------------------Foundation ----------_----------- Prop..Line ---------------------- LEACHING LINE kV No. of Lines _- J_______________ Length of each line-----45�7 115�1 --------- Total Length. ,____ ........ D' Box .__ ------ Type Filter Material -------- __J'---Depth Filter Material ---- Distance to nearest: Well°__ __ '__ _ ___ Foundation ___ ____ Property Line f( SEEPAGE PIT Depth --_ Diameter ________________ Number ----------------__- Rock Filled Yes ❑ No .C] Water-Table Depth -----------------------------z------- -=---------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ----------- -------- Prop. Line ---------._______:_ IR ADDITION(Prev. Sanitation Permit# ________________ Date __________________,-___---_______j s ! J Septic Tank (Specify Requirements) ------------- ------,:--------------------------------- =` _-- _. _ Disposal Field (Specify Requirements) ------ -----C '' ---------------------------------.----------- --= --------------------------- ------------------------- ----------- ----------- -=--=------ (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 ssued, I shall not employ any person in such manner as to become subject to Workman's Compen3atiion'laws of California., Signed Own k BY - ------- -- - ------- Title --- ------- --------------------- (If other than owner) FOR DEPARTMEffT USE ON Y APPLICATION ACCEPTED BY --------------------------- ------ = ----------- DATE --------------------------- BUILDING BUILDING PERMIT ISSUED --------- ---------------------- ---- DATE --- --- ADDITIONAL COMME=NTS ---------- =---------- - ---------------------------------- ----------- ---- -------=---=--------------- -----------------------------------------------------------------------------------------------------------------------`------=----------------- -------- ------------------------------- ------=-------- ---------------------------------- ------------- ------ -- ----------------------- _ _ _----- -------- ------------- -- - ------------------------------------------------- -------- - -----_--- FinaE Inspection by- - � i�Date --- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M