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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT - ---------- ------- ---------- (Complete in Triplicate) Permit No- -----_:___ 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/IOCATI N _ . �;( , _ CENSUS TRACT (� n Owner's Name - `$ _ -lam Phone �JY�f_� f Address =--------- ---------------------•---------------------------------------------1- City -G14 �(_rC� - ----- Contractor's Name -- - -- j- p- l G --------.License # _ f �- -J-- Phone97_(.-J_ __(a 0 Installation will serve. Residence ❑Apartment House© Commercial:❑Trailer Court !❑ �I Motel ❑Other Number of living r 1 bedrooms ___-'____Garbage Grinder --40 _ Lot Size _--cam_ units:___-- -� Number of bedroV ----------------•-""""-- Water Supply: Public System and name __- kiV " " Private ❑ ------------------------------------------"----------- Character of soil to a depth of 3 feet: Sand.'K Silt❑ Clay ❑ :peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan C] Adobe-E] Fill Material -,---------- if yes, type ---------------------------- (Pl'ot 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 [ ] SEP Size___ __/' �' �] 5-----A---/.s--------- Liquid Depth _A/------------- p cit Z�. - - Type C ------- aterial----- No. Compartments -------------------- Dista -Ca a --------- 6 Distance to nearest: Well __z `?�,Q- Foundation ---------------------- Prop. Line ---------------7 -•"- LEACHING LINE [ ] No, of Lines --14----------------- length 9f each lin ��-�D-`-�Q-= al Length _.�y,_>?-------- a 'D' Box ------------- Type Filter Material "- pth Filter Material - ----"_"""-_""_"_" ----------- Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ------- ------------- SEEPAGE PITDepth -----------------------_._ Diameter ________________ Number ----- ---------------------- Rock Filled Yes El No i❑ Water Table Depth ------------------------ --------Rock Size --- Distance to nearest: Well ________________________________________Foundation - - --_- ------------- Prop. Line ---•--•--------------- REPAIR/A DITION(Prev. Saniiation Permit# --------____-___.--------____-"- Date Se ank (Specify Requirements) Disposal Field (Specify Requirements --___ _ `�C�.�.. Qp -- ---_- ----------- -- (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 rformance of work for which this permit is issued, I shall not employ any person in such manner as to becom t Wo a s mpensation aws of California." j Signed Owner r By ------------------------------ -------- -----=------ -------------------------------------------------- Title ------- ------------------------------------------------------ o#other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. _ _- BUILDING PERMIT ISSUED . ------------------------------------ ----------------- DATE _- 2v l� --------- _DA E ----- ADDITIONAL COMMENTS ---------- _ _ - -SLY..- -- - - - ----- - �"-- - --- -- --- ----- --- -�----'- ---- -_ : -__----:_ ---- -------- ----------------------------------------------------------- ------------------------------------------ -----------------------------------•---- --------------------------------- - ---------------------------- -------------------- ---------------------------- -- -� - - -------.-- --- Final Inspection by: __ __-_Date __.. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.