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FOR OFFICE USE: oe APPLICATION FOR SANITATION PERMIT __ __�� (Complete in Triplicate) Permit No. t--`l__L----------- t-2q � �U Date Issued i _ _�� _o________________ 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --- �--�- `_- ,y -------------------CENSUS TRACT -------------------------- Owner's Name ---- "'"��k'r--'�--�-'-��a_--s------------------------------------------------ -------------------Phone .-----------------•--------••-•-•--- - Address ----------- �'✓--- ------------------------------------------------------------------ City -----------------------------------------•------ Contractor's Nam � fiy, T"�/ ----------------------------------------------------License#/46F;-Z-f G-- Phone 19;0=� _ Installation will serve: Residence (Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:_____ _____ Number of bedrooms __;*�------Garbage Grinder 4,1601P-_ Lot Size 1:;�K/�?' —_�------------------- Water Supply: Public System and name ------ -------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam EJ 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 [ ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity ____,___ Type ___________________ Material_____________________ No. Compartments Distance to nearest: Well ___________________________________Foundation _____________________ Prop. Line ._.................... LEACHING LINE [ ] No. of Lines ___________________ Length of each line---------------------------- Total Length ,_____-_______---------:---. 'D' Box ________ Type Filter Material--------------------Depth Filter Material --------------------._...................... V) Distance to nearest: Well ________________________ Foundation ------------------------ Property Line __-•_-_--___-__•--.-.•__ SEEPAGE PIT [ J Depth _ Diameter ________________ Number -------___------------------ Rock Filled Yes ❑ No 0 Water Table Depth --------------------------------------;---------Rock Size -----------•--------•----------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... (o REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date __-___-_______--.___--____________) Septic Tank (Specify Requirements) ---------------- - j .............. t0 Disposal eeField (Specify Requirements) 6 `/= =f`°—if' `-------------------------------------------------------------------------------------------------------------------- 11 ------------------------------------I--------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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: "1 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 Workman's Compensation laws of California." Signed --------------------------- '-- ---------------- --- --(---- - --- ---------------------------- Owner BY t -- --owner) ---- ------ Title ----- ------------------------------------- ------- (If other n owner) R•-DEPW§MNT USE ONLY APPLICATION ACCEPTED BY =u - ---------------------------------------------------. DATE J BUILDING PERMIT ISSUED --------------------•-•----------------------------------------DATE ------------------------------ ADDITIONAL COMMENTS ---- -------------- A - - ------------------------------------- - tai ------------------------------------------------------------ ------------------------------ --------- ----------- - - ------ - -- Final Inspection by �- --------------Date �------ ----�J SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M