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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -----=------------------ ---------- (Complete 7-6-37- - -- - (Clin Triplicate) Permit - ---- -------------------------------------------------- No. 6. Date Issued ---- 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .___ Z___ _-__ �"�f_'_-- �.r---/L" -------------------------- -- !�--------------------------- CENSUS TRACT Owner's Name . _ 2 Phone -------------------•---------------- 1 c�. _.�= _ �'---------- �` fz� Address __ ��- --------�-----@ -- - �� -�-�`/�-�------------------•--- City -�1 -0�----- - _ �'" = f�� .l/`-----------------=---- �_Q Phone Z23�4 s-_ Contractor's Name -___�i-__ ___.License # _ . ,.,� . __ Installation will serve: Residence Apartment House,0 Commercial []Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units_____________ Number of.bedrooms 0--- Garbage Grinder ------------ Lot Size -- ci a :- -------- Water Supply: Public System and name I ------- ---------------------------------------------------------------- Private 5r Character of soil to a depth of 3 feet:';Sand [ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ 0'7 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.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) kPACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------------------------ Liquid Depth ____---_________-___-_____ �n Capacity ------------------ Type -------------------- Material-----=---------------- No. Compartments ------------_--- .... F Distance to nearest: Well ____________________________________Foundation _____ _________ Prop, Line ----------I.._..__. LEACHING LINE [ ] No, of Lines ---------f-_---------- Length of each line------/©a_..------ Total Length / .....__ ` 'D' Box ------------ Type Filter Material ROC/4-Depth Filter Material ____ ________________________________ �1 Distance to nearest:-Well �____ 1 ____ /d___ -_� 14, 4) _.----____-- f_____-- Property Line --!_____._•:--•- � "`' f SEEPAGE PIT Depth ________________ Diameter --------- --� -..Nunber -------`=-------------------- Rock Filled Yes ❑ No Water'Tdl5 e.Depth-=----------------------------------- --------RocvSize ---- -------------------- ------ Distance to nearest: Well --------------------`-------- ----------Foundation -------------------- Prop. Line ---•----------------_ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------ = '`--------- Date --------------------------------_1 Septic Tank (Specify Requirements) --------- -- -d�.��l�-�---�----�0----=-_-- --- -- -- �/N/------� :,�5'��------------ i + Disposal Field (Specify Requirements) -------------------------------------------_--------------------------------------------------------------------- ------------------ -------- -------- -- ---- --- --- - ------------------------------------------------------------------------------------ j (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 as to become subject to Workma 's Compensation laws of California." Signed - ------ - -------- a Owner BY Title --------------------- - ------ ----------------------- - ---------------------------------------------- (lf other than owner) FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY --------------------------------------------------/------ ------ DATE ------------------------------------------- BUILDING --------------------------------- - ---- BUILDING PERMIT ISSUED -- ---------------------------- --- - - ---- - ------DATE ------------- -------------------------- -.- ADDITIONAL COMMENTS -------------------------------------------------------- -------------------------------- - - - -- ----------- ------------------------ -------------------------- ----------------------------------- ----------- --- ---------------------- -- - ---- ---- ---------------------- ------------------------------------------------------------------------ -------- ----------------------------- - - --. -------- - ----------------------•------------------------------------ ----------- f Final Inspection by: Date _ ' E------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E.,H. 9 1-'68 Rev. 5M