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FOR OFFICE USE: -- - ---------------- APPLICATION FOR SANITATION PERMIT -- ------- -- --------------- Permit No: -- ------------ (Complete in Triplicate) ---------=--------------------------------------------- - -.-..-----__.___________________________- __----------- This Permit Expires 1 Year From Date Issued Issued Date --Q['70 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 .- - . -90------ ------------------CENSUS TRACT --------------•----------- +� Owner's Name __ i-��- i Ql-4s-- -- -------------•-- -------- ---- Phone .----------------------------------- =,z:�„+ Address --------------------- P,__V L.-. G -----_•--. City ----------- ----------- -------- ---------------------------------•------ f Contractor's Name ------------ - ---- ------ ----------License # Phone Installation will serve: Residence Apartment House,[:] Commercial [:]Trailer Court ;❑ Motel ❑Ot6r -------------------------------------------- Number -- -------- ------------------------ --Number of living units. ____/ Number of bedrooms __C�__-GarbagCe�Grinder A✓ ___ Lot Size-_A� __Xe k Y S- C1 - ----------------------------- Private ❑ '� Water Supply; Public System and name __. _ _ Character of soil to a depth of 3'feet.,- Sand'❑ (`Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ k Hardpan p , []� Adobe M Fill Material N&If! If yes, type ____.___.._______.________ A (Plot plan, showing size of lot, location of system in relation to wells, buil' ings, etc, must be placed on reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public iewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK'[ J Size-_----------' .------4.- __----_- Liquid Depth -------------------------- W Capacity ----- ----- ------ Type -------------------- Material--------------- No. Compartments ------•----•.._..----- Distance to nearest: Well ------ ------- Foundation _________________ __- Prop. Line __________...:-------- LEACHINGline ��rJ�VVVpt( LINE [ ] No. of Lines ___.___._.________._.__ Length of each line________d___.____:.__.__ Tata! Length ---------------------------- • k - D' Box ------------ Type Filter Material r_________________-Deptli Filter Materia! Distance to nearest: Well -------------------------- Foundation -- iv__________________ Property Line SEEPAGE PIT [ ] Depth -------------------- Diameter _____________ Number _.____._._________._.__'__._ Rock Filled Yes ❑ No i❑ Water Table Depth ---------------`---------------------------------Rock Size;-------- ------------------- Distance to nearest: Wellr- ------------------------•----.._.Foundation -------------- ---- Prop. Line ---------•---------... REPAIR/ADDITION(Prev. Sanitation Permit# ______�_- _________ ---------------- _ Date _________________________________� : f Septic Tank (Specify Requirements) ----------- '. // ------------- --- --- - bisposal Field {Specify Requirement ] -- - - --- ----------(---- --- ---- ----------- --ck.----� 01 p �-�__-- ------ --------------------`----------- --- -- ------- ------------------ ^ (Dr`aw exi'sting'and required'addition on reverseside] I hereby certify that 1 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,liicen- sed agents signature certifies the following: ' ► t "I certify that in the performance of the work for which this permit is issued, I shall -notiemploy any person in such manner as to become subject to Workman's Compensation laws of California." si Signed --- -- ----------- y Owner. ...._..�..w. ------- BY -----'--------------------- Title -_. ;. -- -------------------------- 1�. r ------------ ------------------------ (If other than owner) ' R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- - --- ----- -�,- - --------------= ------------ - DATE ...... -- BUILDING PERMIT ISSUED ---------------------------------------------- rr DATE ----- ------------------------------------- ADDITIONAL COMMENTS -- ------------------------------------ --- -------- ------------------------------ - -- ------------------------ --------------------- _____________________________________ _---------------------------------- --------- _____ --------____________._____________.________.______..______-----------___-__.___-_________ .____._________ _. _ __ .. ____.______ _________________________ ____ ___ ----- ---------------------._-------------------- __ Final Inspection b ---------------------------------------- Date__-_ -----^---1-- -- --- ` SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M