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FOR OFFICE USE: 7�, 7 a. _ APPLICATION FOR SANITATION PERMIT - -------------------- (Complete in Triplicate) Permit No. - _____._____-_____________._____�_-_______________ This Permit Expires 1 Year From Date Issued Date Issued z 8 -7z 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: �j Q� !�ee SUS TRACT JOB ADDRESS/ TION 6.�- ---�---, ------�`7--/-___YY_ -- - Il_. �%�€.N �._.,j Airport wa Owner's Name - - - �"7 - - --------------------------- ------------ -----------------------------Phone Address ----------- ----------------- City ----- ------------ Contractor's Name 6_ . _ __ _ ____ ___ _ _ __ ____ _______License #�_o(,- f� Phone __ �"0.3__�/_ Installation will serve: esidence ❑Apartment House❑ Commercial❑Trailer Court i❑ Motel ❑Other -------------------------------------- Number ------------ -Number of living units:___ ______ Number of bedrooms ----/----Garbage Grinder ------------ Lot Size __ __ __�__________ ______ Water Supply: Public System and name --------------------------------------------------------------------- ------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam JKk 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 is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK5C Size Liquid Depth Capacity/add_______ Type JX14--- Material____________,_______ No. Compartments _ ........... Distance to nearest: Well ------� �-------------- Foundation ____/V----------- Prop. Line __.___ .. pp A LEACHING LINE [ ] No. of Lines __________/______-_ Length of each line______ __!_ ______-_____ Total Length ----- - /-a ..__.... 'D' Box _Z,_____ Type Filter Material _ yy__.____Depth Filter Material ---------2, ___._....f t Distance to nearest: Well ___-�''�__�_i______ �._�- Foundation ____� _____.11_______ Property Line ----15-11 SEEPAGE PIT [ ) Depth ------- Diameter -------- ------- Number ____________________________ Rock Filled Yes '❑ No C] WaterTable Depth ------------------------------------------------Rock Size ---------------------------•--- Distance to nearest: Well _._____________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) ------------------- -------------------------------------------------------- ------------------------------------------ ---------_--- DisposalField (Specify Requirements) -----------•------------•--------------------------------------------------------------------------------------------•--------------- -----------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------••-----------•------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 become subject to Workman's Compensation laws of California." Signed ---------- Owner BY t// %�� . ----------------------------------------------------- Title(If er than Fer) IL FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ ____ _ ____________________. DATE _ate BUILDINGPERMIT ISSUED -- ------------------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS --------------- --------------------------------------------------- --------------------------------------------------------------------------------------- -------------------------------------- --------- ------------------------ --- --------------------- - _ ---------------------------------- --------------- -------------------- --- ---- --- -- --------------------------------------------- � _. Final Inspec -- Date -- - 7_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M