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y FOR OFFICE USE: • ' APPLICATION FOR SANITATION PERMIT o ----- -------------------------- ---- - s- Permit No. --------------- (Complete in Triplicate) __. ---------------------------------------------- Date Issued )d -------------------------------------------------------- This Permit Expires 1 Year From De Issued Date Application is hereby made to the San .Joaquin Local Health District for a permit to+onstruct 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 ------�� v (---------- 1 CENSUS TRACT _-- J...... Name A != '= - /1 -H. L- ------------------------ Owner's ` Phone Address 1/ �r? __ J _ C? � � �` City ,� -- /_ntT = License # --- ` I Contractor's Name __._'tds,�S1 q_4-R,-__- �.-----,_ -- Phone ---------------•--_._._. -------------- -------- --- - I I Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court'A ❑- , 1A Motel ❑ Other -------------------------------------------- Number of living units---- Number of bedrooms �,1'____f.Garbage Grinder JlVb__ Lot Size --__"I`_______ Water Supply: Public System and name -------------------------------------------------------------------- i_ C>__i --------:---------Private j-------- �~ v � , t Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ San8y Loam Clay loam ❑ Hardpan ❑ Adobe ❑ _LY Fill Material q___� fyes, type __ _________________________ f. (Plot plan, showing size of lot, location of system in relation to wells, building`s, 11etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT SEPTIC TANK: Size_E_?__X___�O.5._-- F 1 f! E [ ] �,� � ..r � '---- - I L�quid Depth -- --'--�--- Capacity �a'o Type. _ `Material___ 1 ._ )_ ___ Nor-�Compartments ___'' ........ { Distance to nearest: Well ______Foundation;__ _ p. �-- � ------ --- Pro Line ---_-�-•----- --- LE;4CHING LINE V-1 No. of Lines ___.__ --- -- -_ Leggrth of each line______ uJn#aI Length ---aa --• _._-__ 'D' Box y_iST Mnal) DcC� --Depth Filter Matenai --------------------------- 14- -_ -- -Distance to nearest: WelI / _ oundation � .___ -- Pra.perty ------------------ XLine _-� L P i.SEEPAGE PIT [ ] Depth ___________________ Diameter ________________ Number ---------------------------- Rio&'ilied Yes E] No C]C7 Water Table Depth -----------------------------------------\---Rock Size ----------------- -�t--------r % Distance to nearest: Well ______________________________________Foundation -----------�_.____ Prop. Line ________•______.___.. RI}!'AIR./ADDITION(Prev.((.Sanitation_P�ermit#.-,:,-----: - -.-:---_�.�:---- - — Date ----------------------- --------} ySeptic Tank {Specify requirements) _ - " ' ------- --^ - ---- ---- -- - - - --- Dis osal Field (Specify Requirements -� w: i -:s iN P [ P Y q; } -------------------- --------------- --------•------------------------------ ------ ---------------�----------- - -- --------------------- -------------------------------------------=----------`---------------------- r'---------------------- - `- .�- {Draw existing and required addition on reverse side) I hereby certify thatjI have prepared this application.and-th at.the.-work will be done in accordance with San Joaquin County Ordinances)State Laws, and Rules an Regulations of the Son Joaquin Local Health bistrict. Nome owner or licen- sed agents signature certifies the following. 461 certify that in the perfor',mance of the work for which this permit.is issued, I shall not employ any Lson in such manner as to'becomesubject to �M1/orkmpn's Com nsdtion laws of California." r Signed _ / ,�/ �� jjj � f �U=-`� -J�-�- �- ��'` �� i -----------------------------•-- Owner BY -------- --------------------------------- Title ----------- - ----- - - ' {!f other tharl owner) FOR DEPARTMENT USE ONLY ` BUIL NG'PERMIT-ISSUED - ------------- ---- - ----------------------- -------- ------------------------------------------- a ---- APPLICATION ACCEPTED �Yt `- ------------------------------------------------------- -- -----.- .---__ DATE -- ._ll _'.1es_' -s--------- - -- - -------'�--- ----------- -------- --------DATE - - s � ------�- -- -- ` ADDITIONAL COMMENTS ---------- ---- ------:�._..►- --------`-,)r---------------------------------- - . --- ---- --- -- -- ----- --- - -- -------- - ---- ----- ---- - ----------- ------------------------------------ - ------ -------------- -------------------------------------------------------------------- ------------- ------------------------- - -- ------------------- -------------------- --------------- - Final Inspec i Rate r - ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT fAr� E. H. 9 1-'68 Rev. 5M �� ;