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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� (� ----------------------------- � (Complete in Triplicate) &"-,/ ,//Permit No. ,�1`7__ _-.�D � - ---------=----------- - - r------------- ------------ This Permit Expires 1 Year From Date Issued Date Issued _________________________________________________________ Application, is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein describe This a plication is made in compliance with Count Ordinance No. 549 and existingRules and Regulations: JOB App�� 5 x'-13 S� ESS/LOCATIO�_�4I-�-� C L------ ---p ---i�(f-!- --CENSUS TRACT ------- --- ----------- Owner's `Name -� / c' v ------�--�-.i-4-_ ------ Phone Addressi— ,r- 1f� 4- -- ---- L�------------ --- City -M_i'9-y-Vto- C Contractor's Name -- _ _./�;,----r-� _-- -1-,e------- -- - -�1 Phone �1 Y Installation will serve: Residence ["Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of living units:---- ------- Number of bedrooms ---?--a-----Garbage Grinderx45__ Lot Size —------_----- Water Supply: Public System and name -----------------------------------------------•--------------------_----------------------------•-------_-----Private Character of soil to a depth of 3 feet: Sand% Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material M0----- 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 -----------------i -----------------Foundation ---_--__-__-_--__-__ Prop. Line ...................... LEACHING LINE [ ] No. of Lines ---__--_-------__----_ Length each line---------------------------- Total Length _________-___________.____ 'D' Box ------------ Type Filter Material __ ________________Depth Filter Material ---------------------.____________._________ Distance to nearest: Well _____________________ __ Foundation ------------------------ Property Line ____-_.__.____.__ ------ SEEPAGE PIT [ ] Depth --------- ---------- Diameter ____--_____ -___ Number ---------------------------- Rock Filled Yes '❑ No i❑ Water Table Depth ---------------------------- -----------_---Rock Size -------------------------_ Distance to nearest: Well _____________________ ________________Foundation -------------------- Prop. Line _._________.---------- REPAIR/ADDITION(Prev. Sanitation Permit# ________-__ --______------- -------------- Date ---------------------------------- Septic Tank (Specify Requirements) ------------------------------------------------- -------------------------------•-------------------------•------•---.__-----------4 ---------- Disposal Field (Specify Requirements) ��/ �[)/__ _____ � 4✓�____� 7W4 -____ "__---� ___cotj!��_ SVT_ToNle-----I t�------JEKUST-1-N-C-- -_MN_K 5- ------A5T- _16^- ----------- ------ '4'EA_C_k"E-------L/nl-�---',`" _ FF--PA6�------]--r-------------------------------------- -------------------------------------------------------------------------------------------------------------- (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: "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 bTr;;; Compensation laws of California." Signed -- -- ------ ----------------------------- Owner By ----- - ---------------------------------------- Title _'.-------------- ----------------------- -------------- ------------- (if other than owner) ttt/// p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 ` ------------------------------------------------------_---------------- DATE -----��" �� = BUILDING PERMIT ISSUED -------------------------------------------------------------------•-------------------- --------------DATE --------------`-=------- ------ ---------- ADDITIONALCOMMENTS -----------------------------------------------------------------------------------------------------------------•-------------------------- ----------- ------------------------------------------------------------------ ---------------------------------------------------------------------------------- ----------------------------------------------•------------ -------------------------------------- ---------- ------------------------------------------- - - - - - - - ---- Final Inspection by: ----------- - Date- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M