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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------- ------ ------------------ Permit No: -6-9--F-76 6 (Complete in Triplicate) ------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued A0-`_ ---6P 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: ff JOB ADDRESS/LOC ` -- �,-CENSUS TRACT -------------------------- -ed Owner's Nam�� -- '�•------------ --- ----Phone ismer �� c3 ---------- �-- ------ Address City Contractor's Name ; mac- =��`±-'^license # -��z�3lp,p Phone --------- ----------------- Installation will serve:- – Residence ❑ Apartment House❑ Commerci 1 :❑Trailer'Court ;ElMotel ❑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 1e, Clay Loam :❑ { Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ---------------------------- (Plot, .______________ --____(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 s;�Kge pit permitted if public server is available within 200 feet,) l f _, s PACKAGE TREATMENT { ] SEPTIC TANK'[ Size_ -1�--�-- �' ---:- .� --:- Liquid Depth ---V--1 ` Capacity - - - ----- Type - -------_�� Material „ No. Compartments _ -----•--_--- � k \ J stance to nearest: Well .-____-_�__ __________________Foundation 14---------- Prop. Line i LEACHING LINE [' No. of Lines -------I-------------- Length of each line------I.O0_----------;Total Length _____________ `Q' Box Type Filter Material =__.Depth Filter Material ------/.f;--------________________________ ! Distance to nearest: Well ________________________ Foundation -------€-------------F- Property Line -------M-__-_-__._.___ SEEPAGE PIT [ ] .} Depth -------------------- Diameter ---------------- Number _..y'-------------'----?_ Rock Filled Yes ❑ No .i❑ { � ! Water Table Depth ------------------------------------------------Rock Size ----------------------------•- � t Distance to nearest: Well ________________________________________Foundation _______---_- ------ Prop. Line ____-_--._______--__-- REPAIR/ADDITION(Prev. Sanitation Permit# --------.----------------------------------- Date ----------------------------------I SepticTank (Specify Requirements) ---- - ----------- ---------------------------------------------------------------------------.---------------------------- Disposal. Field (Specify Requirements) ---------------------------------------------------------------------------------------------------------------- -------------------- ---- ------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------- ' (Draw existing and required addition on reverse side) 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, 1 shall not employ any person in such manner as to become sub' to Workman's Compensation laws of California." Signed ........... ----- -- Owner - ------------ _ BY - - -- ---------- ---- - r. Title ' '�1------------------ ------------ ---- ------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -fir ,� / �� -a -------------- ------------ DATE -- �------- -- ----- BUILDINGPERMIT ISSUED ------------ -- - ------------------------------------------------------- ---------------------------DATE ------ - ------------------------- ADDITIONALCOMMENTS -------- -------------------------------------------------------------------------------------------------------------------------=------------- ----- --- --------=------------------------------------------------------------------------------------------------------------ - i - --------------------------------------- -- ------- -- - - - ----------- - - --- -- ------- - --- - Final Inspection by �� '� Y Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M