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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' :L '>:g' ,"' . Permit No: --- ------------------ .-��. r - _.��-�.-.-..• P-�-�----- (Complete in Triplicate) ---------------------------- - p Date Issued 73 I t This Permit Expires I 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 d described. This application is made in conplicfnce with County Ordinance No. 549 and existing Rules and Regulations: `S/ -`�—CA "` - Q .CENSUS TRACT -------------- ----------- ------------JOB ADDRESS/LOCATION ._.�/� s±' -�. / ' Phone .�f^ 7 Owners Name /j ----- :. . P t Address _..._ �� - �cJ ------- 8 ----------- City Contractor's Name ---- -L±� License # -- -7,7 ',�Phone Installation will serve: "� Residence Apartment House'❑ Commercial ❑Trailer Court :0 � i .Motel ❑Other _.__- ------------ � r f --- Number of living units:__._ ------ Number of bedrooms ------]___Garbage Grinder ._. / - Lot Size _'� Water Supply. t and name ------------------------ Private ❑ Pp Y,. �" Character of soil to a depth of 3 feet. , Sand'❑ Silt❑ Clay ❑ !Peat❑ Sandy Loam ❑ Clay Loam ❑ ..:. . . ...._ . _ .�° I Hardpan E] Adobe Fill Material ---------.__ If yes,type ---------------------------- (Plotfplan, showi g size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEWS INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) l _ Liquid De th __ SEPTIC TANK' Size r ` q p PACKAGE TREATMENT [ ] x �7 1 - �aterial( � Compartments I ; - I �`, i Capacity �D TYPe ,. I l c, .lit Distance to nearest: Well -- Foundation ------------ Prop. Line J------------ --•--- LEACHING LINE ( No. of Lines -_ -/---------- -- Length of+�!line__-_ ------------ Total Length -- ___--------- o ri I ------ D' Box L)-- Type Filter Material -- Q� Depth Filter Material _,__�- �" Foundation Property Line ---- ------------•----- Distance tYo4nearest:•WeN ---------------------- - - --�-�--------- P HY I Rock Filled Yes No .C] .SEEPAGE PIT De th -Q. ----- --- Diameter a-x_D____-- Number ------ ------------- _ f � ! P ' Water Table Depth I Rock Size -------------------------------- O - Distance to nearest: Well _____________----------_--- - --- ------Foundation -------------------- Prop. Line -----•-- ---•-- r REPAIR/ADDITION(Prev. Sanitation Permit S# --------------------------------------------- Date ----------------------------------) fr�. i Septic Tank (Specify)Requirements) ------------------- ------------------------------------------------------ Disposal FieWmSpeci,fy Requirements) -------------------------------------------------------------------------- -- I ------------ --------------------------------- -------------------------�------------------------- t I (l7ravv-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: a "I certify that in the performance of the work for-which this permit is issued, I shall not employ any person in such mnner as to become subject to Workman's Compensati laws of California." Signed ----------------------------- ------ ---- -- --------- - - ----- -- Owner -Title ----- --- ----------- --------------- ,Vf-other than"ow r ' FOR DEPARTMENT USE ONLY 91 APPLICATION ACCEPTED BY _._ -------------------------------------- --- ----------------------------------------- - BUILDING PERMIT ISSUED ----- ---------- --- -------------------------------- --------------DATE _. - ADDITIONAL COMMENTS - .--------- ----------------------------- -------=---- ---------------------- -----------------------------------.--------------------------- ------------------ Final Inspection by: _ __ _ _ Date ------- --------------------------- --- ---- ---------- ---- ---------A UIN'LOCAL HEALTH--DISTRICT -------- -- SAN JO Q E. H. 9 1-'68 Rev. 5M.