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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _.` -Z----_ZY, ---------------------------- This Permit Expires 1 Year From Date Issued Date Issued --- Za -2-S? - 104 --a& - 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: A-4E JOB ADDRESS/LOCATION ._i _ -- --� 1c3 L _, 55"'Ae � {a yj ENSUSTRACT ----- Owner's Name [__!_/ ti� ( f _-A 4W/L---- � ------------Phone Address --f ��_ / �------/-'7-4_-=C--- ---------- r G Contractor's Name I�'1 V j .. ... --------------------------------License 4C47 F if---- Phone ------------------------ Installation will serve: Residence [q Apartment House[] Commercial ❑Trailer Court ;❑ Motel ❑Other Number of living units:______ Number of bedrooms _______Garbage Grinder ------------ Lot Size - - --------------------- Water Supply: Public System and name ------------------------_----------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material __i�� If yes, type _________-___________-_ (Plot plan, showing size of lot, location of system in tion to:4ells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: {No septic tank or seep pit permitted iff public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAN K [ Size---��?---X----��-�Q___ -"--- Liquid Depth __`T_at—__.---____-- Capacity _ --_- TYpeI--- --"--- -----44� Material__ No. Compartments __ _.__ ante to nearest: Well ------la1 .......................Foundation _-�_-��--------- Prop. Line ----4`?__-1-----_--- LEACHING LINE [ No. of Lines ....�-------------- Length of each line.------ --------- Total Length _ _-.--_--- 'D' Box Type Filter Material _ __- - _ Z-- �'� Depth Filter Material ___J Distance to nearest: Well --_ Foundation ------------ Property Property Line _ _ __f r ------------ SEEPAGE PIT [ 1 Depth -------------------- Diameter ---------------- Number -----_---- ----------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------- -----------Rock Size ------------- Distance to nearest: Well _______________________ _ _Foundation -------------------- Prop. Line --------._--________ REPAIR/ADDITION(Prev. Sanitation Permit# _______ ------------------------------------ Date -----_-_._______-_____ ) Septic Tank (Specify Requirements) ----------_________________ _ Disposal 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 become subject to WorkTn's Compensation laws of California." Signed ---�- --- t Owner BY - ----- -- `---- ----- (I other than owner) Title- - ------ --------------- -- ----------------------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ DATE ------ - 7 ------------------!--�------------------------------------------------------------------------------------ BUILDING PERMIT ISSUED ----------------- _- ---------DATE -------------_----------- ADDITIONAL COMMENTS -------------------------------------------------- --- ------- -- ------------------------------------------- --- ----------- --- -------- --------------- ---------------------------------------------------- - - - ----- -- ---- ------- - ----- ----- --Finallnspectionr Q ----. ------ ------Date -- -- ----- Final - r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M