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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- (Complete in Triplicate) Permit No. ---------------------- ---- --------- Date issued _______ - ------------------------------- This Permit Exp'ares 1 Year From 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. 55A9 and existing Rules and Regulations. JOB ADDRESS/LOCATION ._�49� ---' `-- �< r °d -CENSUS TRACT --------•----------------- Owner's Name --------�1-16t,lS------------------------ --------------- -- ------------------Phone .�. ---- Address �_� ?2/ •� .? __. .. - -------------------------• City _ 1 ---------------------------------------------- Contractor's Nam --------------------------------------------- Contractor sham . ,4e-' ��------ License # /--- Q�4_ Phone -------1•?-.------- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer GMrrt ',D Motel ❑ Other -------------------------------------------- _ Number of living units:__.--- --- Number of bedrooms ---;-7,----Garbage Grinder -.tri__ Lot Size --------`---- ----1_-----°-- Water Supply: Public System and name -------------------------------- ----------------------------------------------- --------------------- Private ©O Character of soil to a depth of 3 feet: Sand'o 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 is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size-------------------------------------------------- Liquid Depth -----%------ --------- Capacity Type Material--CePit�. ._-- No. Compartments _--- .............. Distance to nearest: Well ____Jf Cy ____________-___Foundation —40---- --- ----- Prop. Line _! ______________ LEACHING LINE [ ] No. of Lines ----.___7------------ Length of each lined f7 +Jfffota! Length ___--1-Q� - - -------- 'D' Box ___ ____ Type Filter Material __1Yr<�JCDepth Filter Materiaf _____1 _14___________________________ Distance to nearest: Well _.� `-/-------- Foundation .L4__'--__._._____ Property Line __l _.`_ -------- SEEPAGE PIT [ ] Depth h/—�__ -------- Diameter �T- � Number ------_J------------__---- Rock Filled Yes [i;,, No i❑ Water Table Depth ------------------------------------------------Rock Size ---- -------------- Distance to nearest: Well ---------f-��__�-------------Foundation -, � Prop. Line .1Q__y"__._____ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------------------------------------ -- ------------- ----------------------------------------------------------- DisposalField (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, 1 shall not employ an rson in such manner as to become subject to Workman's Compensation laws of California." Signed ------- ----- ------------=----------------------------------------------- Owner By --- ------ !__L.af.�J�cQT��F-4'�1 � Title f� - - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE -- BUILDING PERMIT ISSUED --------------DATE ------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------.._---------•---------------------------------------------------- ----------•---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ---------------------------------------------------------------- ------- ------------------------------------------- ------------------------------- ------------------ ----------------- II -- Final Inspection by: ------ ------ ---- -- -------- Date ! � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M