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FOR OFFICE'USE: . APPLICATION FOR SANITATION PERMIT - ----------------------- ----------------- Permit No. `� (Complete in Triplicate) __________I 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 Ord' ante No. 549 and existing Rules and Regulations: , JOB ADDRESS/LOCATION . f -sra._ !_!Q#?D 1�� _��000///.29 ___-_ 117 E _CENS S TRACT __________ U Owner's Name _ Q�¢trl4'�l �11_,(1 ---------------------------- - ------ -------------- Phone 0.�.�- Address --�0,V1_ t&---------------------------- ----- ----- 0--- ---". city _��7 ��------------------------- ---------.---•------ Contractor's Nam _A liR �,ci >[a _ _ _ License # _._-___ _. .� �` __----- Phone ^� Installation will serve: Residence ❑Apartment House 112:Commercial []Trailer Court i❑ Motel R,Other �--------------------------------------------N6. Number of living units:___-_ Number of bedrooms :__ _____ _ __Garbage Grinder ____ .-_ Lot Size ______________ ___ _ _____-_____---_ Water Supply: Public System and name ----------------------•----------.__.------------------------------- ------------------------------------------PrivateX Character of soil to a depth of 3 feet: Sand'M Silt❑ Clay ❑ Peat❑ Sandy Loam K Clay Loam ❑ uh Hardpan ❑ Adobe ❑ Fill Material _-tJ©___ 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 -_.________---..---_---__ L) 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 -------------------- ...................... Distance to nearest: Well ________ Foundation ------------------------ Property Line -----------------_---- SEEPAGE _______-_______- ---_SEEPAGE PIT [ ] Depth -_----------------- Diameter _______________ Number _-____-__. ----------------- Rock Filled Yes '❑ No i❑ Water Table Depth ------------------------------------------------Rock Size Distance to nearest: Well ________t_____________________________Foundation __ ---------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# d 8� b_ _4 ----------------------- Date 1 _�.-___.______) Septic Tank (Specify Requirements) ---------------------------------------------- --- - - - - --------------------- Disposal Field (Specify R quire nts) Q r 7 / --- f---------------- - -- - ------ - - - - /� - e e '-----------------------------------------------------•------------------•-------"- ----------- --------------------------------------------- --------------------- -------- - --------------------- ----------------------- ------------------------------------------------ (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, 1 shall not employ any person in such manner as to beta a subject to Workman' Compeniiation laws of California." Signed _- -.. BY - ----- Title -------,1=--------------------------------------------------------------- - - - - - - - - - - ---------------------------- - - - - -- - - - - - -- - (If other than owner) FOR PARTMENT USE /NLY_ APPLICATION ACCEPTED BY -----Li._ ka---------- ------------------------------ ----------------------------------. DATE ------'��- ---- �...... BUILDING PERMIT ISSUED _____-______._____ _ ___________DATE ______________ ADDITIONALCOMMENTS -- ---------- ----- - - ------ ------------ ------------ --------------------------------------------------------------- -------•-••---- ----------- ---------------------------------- -------- - ------------------ ---- ----- -- - _ ------- Final Ins n b - - � ��--- -------Date --------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M