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FOR OFFICE USE: �� APPLICATION FOR SANITATION PERMIT --------- ----------------------- ------ -- ] •-- (Complete in Triplicate) Permit No. ' p p ---------------- This Perrnit Expires 1 Year From Date Issued Date Is ARM -,Y_ �=_7 J 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 Regulationsi JOB ADDRESS/LOCATION .------- - -- ----,. ,---- --------_ ------- CENSUS TRACT -------------- ----------- � Owner's Name ' -.r�s�y` ----------------------- ------------- -- Phone ---------------------------- Address --------m -t ---------- " --- City Contractor's Name -_.____-- _-- _ _-- -- =--- ---------- ------------=--------License --- Phone i Installation will serve: ResidenceXApartment House ❑ Commercial ❑Trailer Court �❑ Motel [:]Other ---------------------------------------- -- j* r Number of living units------- _____ Number of'bedrooms ---e�..._Garba a Grinder _ d Lot Size Water Supply: Public System•and naive ........ ___'_ ' r�� -------------- '------- Private ❑ ..4-.. i Character of soil to a depth of 3 feet: Sand E] *Silt❑ Clay„ ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe&' Fill Material ------------ If yes, type _-______.__;______________ i - i 3 (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'[ ]Jr �ST! Ze "-`--------- --- t-- Liquid Depth ---------------------- i Capacity -- ----------------- Type -------------------- Material-------------- ------- No.' Compartments -------- --------- F Distance to nearest: Well -------- ------ - - ---- - - - -----Foundation --------------------- Prop. Line ------ _ LEACHING LINENo. of Lines ------- t v ` ------------- Length of each line-----.f��----------- Total Length ----- --------•-- a 'D' Box .___ _- Type Filter.�Mdterial _ ----Depth Filter,Materiai'---/,�p"_________________________ Distance to nearest: Well ---_ --------1 Property Line ---- .______-___-.._- .. _ _.. -- SEEPAGE PIT Depth`"`q� 5.__________ Diameter Num ber --._.__l-----. ______ Rock Filled Yes [ No i❑ p. i---- Water Table Depth /--a----_- -- ------..Rock Size ---4P ' 7 Dish tance to nearest: Well ___,/ ________ _________Foundation __ d`- ------- Prop. Line _..!6--�__ ........ REPAIR/ADDITION(Prev. Sanitation Permit# ___________________________L-___.-J------ Date ------------------._.____________-) r Septic Tank (Specify Requirements) --- --------------------------------------i------------------------------------- - t p , E Disposal Field (Specify Re irements) ---- � ____________ 01- -------------------------------- _ - - - - -------------- ,"""T' -=-•--=-- - --- ---- -- ---- ------------- rpx� - IJV �yJ�y gyp®�--- - - ' --------------------------------------II I 1 ---------------------------------------------- ------------------=------------ - - ------------------- - - ----------------------------------- `'(Draw exisfirig`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 1.1 certify that in the performance of the work for which this permit is issued, I shall of employ any person in such manner as to become subject to Workman's Compensation laws of California.' ; Signed ----- Owner ' .. BY ---- - - - ------ ---- --- f -- Title ------- ------------------------ 4 (If other than owner) ----------------------------- t � FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY __ ----- - ---- ----- i -- -- -- - --------- - ------------------- ------. DATE ----- -- ---- ---------��-- ` BUILDING PERMIT ISSUED -----------------------------------------------------------DATE ------- ---------------------- ----- AL COMMENTS --- - I - - ---------------------------------------------------------- ----- --- -- --------------------------------------------------------------------------------------------------- --- -------- -- Final Inspection by.-,__,--- - -Date -----�_-,�-------.- j-- SAN JOAQUIN' LOCAL HEALTH( DISTRICT` E. H. 9 1-'68 Rev. 5M