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i + FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: --------- --------•--------------- ------ --------------- (Complete in Triplicate) ' ---- ' ---------- ---------=-------------------------------- Date Issued __ _-.�_. :._�_-�- - A 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 -- - UL�;?��1- - / ---------- ------CENSUS TRACT _S... __1-tiry------------ Owner's Name -- ----------- 44._ �y� Phone ------------------------------------ Address LP-.O/ Cit Lan - -------------------------------- i /oFS— -------V1-��/L -- --- ---- ----------- y ----------- Contractor's Name ------� ---------------------License # - -------.--------------- Phone ------------------------------ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ MotelOther -------------------------------------------- Number of living units_____________ Number of bedrooms ---3-__Garbage Grinder ------------ Lot Size __________________________________--._ .�.V " � Private ❑ 'Water Supply: Public System and name ---of_t-- ----- ----- ----- - Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ HardpanS.-:-,i;-Aclobe�F.—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.} lQ � NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT { ] SEPTIC TANK,NSize--- �C------5 ------ Liquid Depth,, --------------------------- -[ 6 - rtments ---� ...------ O Type Material----------- ------ No. CompaCapacity Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------------_......... LEACHING LINE jjd No. of Lines ________-,.--------- Length of each line----/Ood,------- Total Length 'D' Box ...;-..--- Type Filter Material �_1_02-----Depth Filter MaterialV--A_-t-.......... Distance to nearest: Well ___ __------ Foundation __-______ Property Line '- -- SEEPAGE PIT Depth � -_____ Diameter 13_;�_ _______ Number — - ---------- .---- Rock Filled Yes ,fs No ----Rock Size --- �� ' Water Table DepthaD --------- Distance to nearest: Well ....13!p�--------------------------Foundation __.___-_ Prop. Lin e'_._____.............. REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ----------- Date ------------ .`?----__----------} Septic Tank (Specify Requirements) ---------------- -------------- --------------------- Disposal -----------------•-Disposal Field (Specify Requirements) -------------------------------------------------------------- -----------------------------------------------------:1-------------- --- --------------- ---- ---------------- ___________ _ _______ ______ _ - �4 * -----_ ----------------_ __ __ ___ _____ ______ _______ ______ Y�" • o d irk i3 (Draw existing and required addition on reverse sided I hereby certify that 1 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, L shall nofi'employ any person in such manner as to b co W 's Compens0.fiion laws of California." i; . -- Own erSigned Title __________________ - ------------- ----------- ------ (If other than------------------------------------------------------------ er) - FOR .DEPARTMENT USE ONLY .a ��t APPLICATION ACCEPTED BY - --- -If DATE �'E' T�' ---------------- BUILDINGPERMIT ISSUED -------------------------- -------------------------------------------------------------------------- DATE ' ADDITIONAL COMMENTS ---------------------- -------------------------- ------------------------------------------------------------------------- ---� -------------------------------------------------------------- ----------------------------------- ------------ - . ------- --------- = Date ` Fina! Inspection by- ------------ / ------- - - -------------------- -_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M