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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT cG Permit No. ._��Y4--`-� ----------------------------------------- ------------ (Complete in Triplicate) _ -------------- Date ---------=---- Date Issued I This Permit Expires 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 comp ' ce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO!N'' {LCSr CENSUS TRACT ------------------- •----- Owner's Name ----J0_6V-- r671✓L Phone ------ Owner's ,G�---/--'16�---- +�� j11 aj d--------- --------. Citym-n—tvY�"��-Phone Address _ .-. ------ a� Contractor's Name . �' J �er1_ ------------------------- -- f -- - Installation will serve: y Residence [] Apartment House❑ Commercial []Trailer Court ;❑ Motel F]Other –------ Number of living units------------- Number of bedrooms ------------Garba_ge Grinder -------- Lot Size --_____--____---____-____----________-___ Water Supply: Public System and name ---- {--------------- -------------•------- ----------------------------------------Private] Character of soil to a depth of 3 feet: Sand 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 [ I SEPTIC TANK:[ ] ize-------------------------------------------- -- Liquid Depth _--------------------.----- Caacit -- Type --------- ---------- Material---------------------- o. Compartments ------•--------- --- P Y ------=----- - YP . Distance to nearest: Well -------- --------------------------Foundation ------ --- ----------- Prop. Line -------------__;__..__ f LEACHING LINE [ I No. of Lines ------------------------ Le th of each line---------------- ---- Total Length ----------- _-------------- ..D' Box ------------ Type Filter Ma rial --------------------Depth Filter aterial --------------------•--------------------_-_ Distance to nearest: Well -------- -------- - Foundation ----- ------- ----- -- Property Line SEEPAGE PIT Depth --- Diameter ________________ Number _---__-..___---- ___----__-_ Rock Filled Yes ❑ No I❑ [ ] p Water Table Depth ------------Rock Size -- -------------------•---------- Distance to nearest: Well ------- '------------------------------Foundatio -------------------- Prop. Line ---- REPAIR/ADDITION(Prev. Sanitation Permit# -------- --______ Date -------- -----------------------) Septic Tank (Specify Requirements) --------------------------------------------------I----------- --------- ----------•----------------------------.----------------- -- -------- Dispos I Field (Specify , Reu'rernents) -s ----- --------------- � ---------- d -------- --- r ----- --------- ---------- --------- ------------------------------- ----------------------------------------------- .-------------------------------------------------------------------------------------- - ' ------------------------------------- (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, I shall not employ any person in such manner k as to become subject to Workman's Compensation laws of California." - Signed ----- Owner Title ------------------- ------------------ -------------------------------- BY (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - _: __ ------------------------------- --------------------------------- DATE A1>---------------- -BUILDING PERMIT ISSUED ------------------------------ - -------------- ---------------------- -----DATE ------------------------- ----------------- ADDITIONAL COMMENTS ------------------ ----- ------------------------=- ----------- ---------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------- --------------------------------------------------------------------------- r --=------- Final Inspection b = � Dote _ �--------------------------` SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M