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OFFICE USE: -- APPLICATION FOR SANITATION PERMIT -- - ------- ---------------- Permit No. 1 (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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._1_,Y_7_J6_-__5-,-_-S--___C�_-��___P___-_Z�� ____________________CENSUS TRACT __-_____-____-._-------__- Owner's Name ------ -----1� --------------------------------------- -------------------Phone Address ___________-_____ ---------------- - - ------ -------- --------------------- City --- -------------------------------------------- Contractor's Name ---- s -- - ---------License #0- S=_VZ7_- Phone7!!- Installation will serve: Residence VApartment House❑ Commercial ❑Trailer Court Motel ❑Other------------------------------------------- � Number of living units:_________ Number of bedrooms _______Garbage Grinder A4>----- Lot Size _ __ _ lg- ------------- Water Supply: Public System and name ---------------------- ------------------------------------------ ------------------------------------------Private 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 its(available within 200 feet,) _ PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size__6`_ a---/ __l-__f __--------- Liquid Depth ____ ............ Capacity -JJ-0.0------- Type-f, - Material--LNo. Compartments ................ Distance to nearest: Well ----- ,l'Z_lt---------_-------Foundation ____ ----------- Prop. Line __s,�'~----_____-__.._ (^ LEACHING LINE [ ] No. of Lines _____�--__________- Length of each line_____F-6--------------- Total length ,____/Z-4............ I 'D' Box _U Type Filter Material ____ _______Depth Filter Material -------151............................... Distance to nearest: Well --------- Foundation ----/-0 Property Line _--�......_....._. SEEPAGE PIT [ ] Depth _�_ T____-___ Diameter 15-YM--- Number ____-z______________- Rock Filled Yes K No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well __________________________________ ____Foundation -------------------- Prop. Line ____--__-.--_-----.--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) I 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 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�s�'L ' t ------ - - ------ -------------------------------------------- Title -------------------- j (If other than owner) 00 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------- DATE �� - r- '3-------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------- --------------DATE ---------------------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- ---------------- -----------=------- Final Inspection b --------------------------------------.Date ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M