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FOR OFFICE USE: `4 ` ; €` N FOR SANITATION PERMIT -e----------------------- --------------------------- _ 4 PPLI�ATIOa" Permit No: __ ----------- � (Complete in Triplicate) -------------------_--_-------_,--_ 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 Ordiinnaance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -----oG. __-/, , Yi � 1---�-L__'------------------ ------CENSUS TRACT -------------- ----------- Owner's ame Gf! 'f2 W_ k P_ !-� ' _ Phone Address �'�------ C�� ------------------------------------------------ CitY `� G Contractor's Name _! -t-__ mment ----------- License # ------------------------ PhoneInstallation will serve: Residence House-[] Commercial ❑Trailer Court Motel ❑Other -----------------------------•-------------- -} Number of living units------------- Number of bedrooms _______Garbage Grinder -je-S---- Lot Size/its--- I-------------------------------- Water Supply: Public System and nameOfi_4 �--------------------------- ----------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loom -❑ Clay Loom ~ ! 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.) Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK Jf] Size-----/,__ ._ _(�_Wf- ____________ Liquid Depth __ ��____. ..------ �� ,, 77�ti - Capacity 4-0.4- _✓f_ Type J0f,4e�Gt�P_f Mate i ---- No. Compartments __-___ ------ � " 1 Distance to nea est: Vfttl7 __---------_------ ------------Foundation ----/0-_______--___,Prop. Line _3----------------- LEACHING LINE [ ] No. of Lines ______ ==___ ______ Length of each line------- --------------- Total Length __________________ D' Box ------ Type. Filter Material Depth Filter Material ----/g----------------------------------- Distance to nearest: Well -----=______________ Foundation ---/0--------------- 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 -----------.__..___._____________- : � I SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------...----------------•-•-.---.-- i Disposal Field (Specify Requirements) --------- ----------------------------------------------------------------------- ----------------------------------------------- ----------•------------------------------------------------------------• -------------------------------- ------------------------------------------------------------------------ I (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. Nome owner or licen- sed agents signature certifies the following: "1 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 bem�sub'ect to Workman's Compen ation laws Ca ifornia." igned ------`....... � � - ` --------------- --- Owner _g - iJ4- By ------------------------------------------------------------------------------------------------------- Title -------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------------------------------------------------------------. DATE ----------- BUILDING PERMIT ISSUED ----------------- ----------------------------------------------------------- - DATE ------- AD ITE AL OM II TS __ o__ _ 4__________________{�_ ___ - ----------- -----------� b-� - -- ��"''=��`-'--- ---- --- - --- -- ---- -- - -- - - --------- ;{� - -... = ----- -- A- ----- ---- Final Inspection by: -------------- ---------- -- ----' I _: - ' _ -'_Date `� �2.-�-- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -_-