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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - --- ----------- ---- -------------- ------------------- /(Complete in Triplicate) Permit No. . { --------- ------ F ' This Permit Expires i Year From Date Issued Date Issued ___-7/1 �./ Application is hereby made to the San Joaquin LocaI 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: L ` JOB ADDRESS/LOC TION / � i ------CENSUS TRACT -------------- ----------- Owner's N ----Phone ------------------------------------ gRRe %F r :, CrAddress 4" License # Phone --�'_------_ -- ----- ---------- --- Contractor's Name Installation will serve:,�i ResidenceApartment House❑ Commercial ❑Trailer Court ,❑ Motel,❑ Other ---------------------------------------- Number `Number of living'units:----/_---- Number,,ofibedrooms - -----Garbage Grinder -_- ______ Lot Size ____________ Water Supply: Public System and name' --------------- ----Private s Character of I,to a depth of 3 feet: Sand❑ Silt,❑ Clay E] Peat E:1Sandy Loam -0 Clay Loam:❑ i -Hardpan ❑--Adobe' Fill Material ------------ If yes,type ____________________________ (Plo,rplan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) X� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT [ ] SEPTIC .ANK Size_ ! _ _ . - - --------- Liquid Depth ---------------___________ 'Ir .�- 011e- Capacity ��/(q_CS______ Type�!lP__e Materia l a�ri____-___ No. Compartments _____------`____---. IDistance to nearest: Well ____. ________________________Foundation " ___________ Prop. Line ____._._- s. C .� 9line-3-4-1--__94--f-- Total Length $C� LEACHING LINE X No. of Lir es - --- Len th of each - _ __ frr 'D' Box __�_�_.___ Type Filter Material J �4_MeDepth Filter Material ____-1_46---__------------------ 1 _e... ' s pistanee to nearest: Well __��________��_ Foundation _.�-�______________ Property Line SEEPAGE-PITDepth -------------- Diameter _7g------- Number ---------�_______ ____ Rock Filled Yeso No .0 - P � i .. I Water Table Depth ---- ------------------------ --------- Rock Size �'.-------------- , Distance to nearest: Well _1W--f------------)___________Foundation -__ _______ Prop. Line -..-___-.______ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I Septic Tank (Specify Requirements) ----------------------------- -----------------------------------•--------------------------- ---------------------------- Disposal Field (Specify Requirements) ---------- •---------=----------------------------------------------------------------------------I--------------- #. ------------------ - ----------------- ------------- - - ---------------------------------------------=------- (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: f "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco a su ject to W rkma Compensati.o ws of California." Signed - ----=4- - f 1 E = - ---------------- ------ Owner a � BY ---------------- ----------- ---- f ------- = Title --------------------------------------------------- -------------------- (If --------------------------- ----- - ---------------------------------- (If other than owner) t FOR DEPARTMENT- USE ONLY APPLICATION' ACCEPTED BY __4--C-------------------- - -------------------- DATE ------7- -�'-Z/----------------- - ------------------- ----------------------- BUILDING PERMIT ISSUED - -------------=--------------DATE ------------------ ------------- --------- ADDITIONAL COMMENTS ------ ---- ------------------------------------------------- ----------------------- ----------- i ° �`�-~ ----- ----- ------ ----- -------------------- ---------------------- ----- -- ------------------- ---------------------------------------------------------------------------------- - - - Final Inspection by - -- - -- - ------------------------------------------------------ -----------date �Z �.... _SAN AWIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 51V1