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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------- Permit No. ........... ......... (Complete In Triplicate) . ....................................................-•--- This Permit Expires-1 Year From Date Issued Date issued:s.3...7� Application is hefeby made to the San Joaquin Local-Health District for a permit to construct and-install the work herein described. This`-application is made in compli na ce with County Ordinance No. 549 and existing Rules and Regulations: M �. JOB ADDRESS/LOCATION`.-. ----:.3.../.- ....�li... . ........ .. .._........................CENSUS TRACT ........1.............111. Owner's-Names .0 .......111.1.........•--......... ........... .......Phone Address ..../ ..._`rl ? ................. City ... ..................1..1.1.1...... Contractor's Name .-`% _...: -�..___.......................................License # f J. L.._. Phone ..16-.... ............_ Installation will serve: F Residence a-A-partment.House❑ Commercial❑Tra€ler Court .0 Motel ❑Othe c_ .............................. Number of livin units._._ --Numt,ef of bedrooms Garbage Grinder `- :�Lot Size . ...... ••--•••••-•.......•••••• g Water Supply.-Public.System-and_name.--------------------- - ......_.-----•-----------------.._... .....--------.....--...--- ----...........Private Character of soil to a depth-of 3 feet: Sand❑ S€It❑ Clay ❑ Peat❑ Sandy Loam Clay Loam D Hardpan ❑ Adobe❑ Fill Material ............ If yes,type ............... .......1111. (Plot._plan,;,showing-size..of_._Iot,_location..of system. ins--relation to wells,-buildings, etc. must be placed on reverse side.h.3 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Q W PACKAGE TREATMENT ( ] SEPTIC TANK 4 I S€ze--------------------------------------•--------- Liquid Depth ................... , Capacity -------------------- Type .................... Material---------------------- No. Compartments .................... ; Distance to nearest: Well .. .. _Foundation ...... Prop. Line ------------- •---•----. 1111._._ ............_._. .................... LEACHING LINE [ ] No. of lines ................... Length of each line---- ........................ Total Length ..-......................... 'D' Box --.- ------- Type Filter Material ....................Depth .Filter Material ........................................... Distance to nearest: Well _....................... Foundation ......- ...... Property Line ..............--1111.._. SEEPAGE PIT Depth -_---------------- Diameter ._.... ......... Number ........................-... Rock Filled Yes ❑ No Water Table Depth ............................................:...Rock Size .................................. Distance to nearest: Well ........................................Foundation. ............. Prop. Line ----......... ........ REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................... Septic Tank (Specify Requirements) --_-------------- ......................... - or Disposal Field (Specify Rquirements) ..dlQ.. 'F' ................. .------......_.......�_........---•-�--......... � - --------------------------------------------------------;� --.-........... :1111. -----------------------=---- -------------------------------------------1111-------------------------------- ---------------- - --........-----..........----...---...-----................. {Draw existing and required addition on reverse side) I hereby certify that t 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 shat] not employ any person in such manner as to bec a ub est to or man' Compensation laws of California." Signed -- ........ -- {- Owner - ------------------- B ----------------------------- -G�� -------�------------- Title ---- Y � f--111.1.----- (if other than owner) FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY --------- --- ------ ----- ......... DATE --- '--,-• :-------------------- I BUILDING PERMIT ISSUED ----------------- -----• ----------- ------ -•-- ...----------•-----.._.._DATE ......... --------------- ....... ADDITIONALCOMMENTS !+ --- -—----.----------_-------- ------------------------------------------------ ------------------._... _1 --------------------- ............... -----------------------------------------------------------------------------------------------------...----------------.......-•---------.._....._.._......._..------•--•-- ------ ----- ...------. --------------------------------------------------------------=............................... ----------------------- .................... .....-- -----------.....--------... ---------- _... _.............. ................ Final Inspection by:0T` _ --=---------- ------------- .................. ----=-•----......._.......... :.....Date Z�k -... F EH 13 2[+ 1-68 aev, SAN JOAQUIN LOCAL HWTH DISTRICT * 874 3M s