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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ 6 -- - ------------=-------•-- Permit No. �,.-�---f g------- {Complete in Triplicate] =---------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued lt?- -73 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/LOCATION ------- -- ------CENSUS TRACT -------------------- Owner's Name -------2 --------- l _?_%*;0 q_ _ 1/1 W_ ------- ---------------------------- -y Address ----- -------`----�-----f•---Q...._ --•- Contractor's Name1C, y--_S T '-- —iC___S,47�.License _ Phone Installation will serve: Residence W Apartment House,❑ Commercial ❑Trailer Court ',❑ Motel ❑Other --- -----------------------•- Number of living units:-- t------ Number of bedrooms __/------Garbage Grinder / ___ Lot Size 1a4V '1r.V---.- ------------ WaterPublic 5 tem -and name ---------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Materia! ------------ If yes,type--------------------------- (Piot 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 ------------------------------------Foundation ---------------------- Prop. Line -------------:........ ---- Tota! Len th -----•-------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------- g 'D' Box --------- Type Filter Material --------------------Depth Filter Material ___-_________-___.__._-___........._....____ Distance to nearest: Well ____________________ Foundation Property Line. ------------ ----------- SEEPAGE PIT [ ] Depth -- ------ Diameter --- Number _ Rock Filled Yes 0 No i❑ N ------------- ------------------------- - Water Table Depth ------------------------------------------------flock Size -------------------------------- Distance ---------------------- -------Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---.----._-__.-.-_---- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---------------- Date _--- __----__.___-.._--,__._--_) Septic Tank (Specify Requirements) ----1*,SL--__J l---_-A'?_aa--- ,- ------ Disposal Field Field (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 any person in such manner as to become subject to Workman's Co pensation laws of California." Signed ---- ---------------- -------- -- - --a Owner By ----------------- �' Title - ------------------------------------------------- (If of r than o er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------- ---------- ------------------------------------------- DATE ...-_---b-cry '.� ------------ BUILDINGPERMIT ISSUED -- ---- --------------DATE -------------------------------------------COMMENTS ---------------------------------------------------------------------------------------------------------------------------------- -------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- rJ Final Inspection b : ---- - ---------------- --D- e (�-_ab----�--_------- P Y � -- -------- ---- -------- -- - - ate -- - -- -- -- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M I