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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate) Permit No. _.__ ---- ------------------- -------- Date Issued -_ -/ � 7 Z This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for ❑ 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 �/"�s� - - ------ ----------- CENSUS TRACT Owner's Name r � � -------------------------- -------�—� Phone Address ------ ----- �-�-- - �a�------ -�_�eFY��J�_�. Cit t s Contractor's Name ------ ---------------- - ----- - - - - - ------- ------ ----- - -- - - -- -------- -License # --- ------------------ Phone ------ --------- Installation will serve: ---••• Residence ["Apartment House❑ Commercial [)Trailer Court I❑ -----•-- -- Motel [I Other --------------------------------- ----- - -- Number of living units:------------ Number of bedrooms -3-------Garbage Grinder ------------ Lot Size -----�vz3 _--��'-��_--•- Water Supply: Public System and name ---------------------------- �� ----•---�- ------- ---------�-'=`- - -' _ Private [� Character of soil to a depth of 3 feet: Sand'pg Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam [I _(► Hardpan E] 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size__ ------ ---- Liquid Depth _ Capacity _��--o_a..-__ TypeA), C- SMaterialY No. Compartments ------- -- _ __ Distance to nearest: Well t �i -- --- -----Foundation ---- --(J----------- Prop. Line ----� LEACHING LINE /Iy�e [ ] No. of Lines _ 3_-_---_ Length of each line..... Total Length -----_ a ' D' Box � ° Ype Filter Mteerial _- rA�-Depth Filter Material fl V` 1 Distance to nearest: Well Foundation SEEPAGE PIT fA.P ----- Property Line [ ] Dep ___ Diameter - um er ------- -- - ---- ---------- Rock Fille es ® No � ------------ -- Water Ta Depth ------------------- -------.R Size --- ------ Distance to near • Well --- -_ __---Q------------------------Found ---------- ----- Prop. Line -------•------------- ADDIT_ p ON(Prey. Sanitation Permit# -------------------------------------------- Date --------------- EPAIR ------) I Septic Tank (Specify Requirements) -------- ____-____ - - ------------------------- isposa Field (Specify Requirements) ------------------------------------- -------------------------- --- (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 beCeome subject to Workman' Comp nsat' n laws of California." Signe By ------------- ------ Title -- ----- (lf er than owner) FO PARTM NT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED _- -- - - -------------------------------- DATE -_ =f— ADDITIONAL COMMENTS ---- ---- ------ --------------DATE ------------------------------ -------------------------- -- ------------------------------------------------- --------------------------------------------------------- ------------------------------------------ - - - - - Final Ins ection b - - _ ----- ---- ------- - - ---- - - ------- --------- -------- ------ ate ------ - -- ---- - -- 'SAN ------------------------ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M 10