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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` -'--- � Permit No. ----�i-- � (Complete in Triplicate) ------- -D--tel ----- ---- ---=--- - - � p Date Issued This Permit Expires 1 Year From 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: - J!,: - ��• JOB ADDRESS/LOCATION _12_4:9------ -r- � ,7-t-'----------- ---------------CENSUS TRACT -------------------------- �, - ------------ - Owner's Name --- S:----- 6?5 -------_ Phone - - - �� City L.�4r_ Address /o0-4TL,------- ItF��1�� Contractor's Name_ 11 �5��-- j7c2Al. �-��G- .License #��-�G./____---- Phone �l�fs--=-r�-p?•• ---- Installation will serve: Residence X Apartment House❑ Commercial ❑Trailer Court :❑ Motel ❑ Other -------------------------------------------- Number of living units:-----I----- Number of bedroom -_----Garbage Grinder ------------ Lot Size"_-- p------------------ Water Supply: Public System and name -- --- ----------1�'-!!•��'d�---------- - Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt fl Clay ❑ Peat ❑ Sandy Loam '❑ Clay Loam ❑ i Hardpan ❑ Adob-c7o 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,) IN PACKAGE TREATMENT I ] SEPTIC TANK'f ] Size--------------- Liquid Depth -----------------•-------- V Capacity ----------l--------- Type -------------------- Material---------------------- No. Compartments --------------------- Distance to nearest: Well ------------------------------------Foundation --.------------------- Prop. Line ----------. ---------- LEACHING LINE [ ] No. of Lines r-__ _------------- Length'of each'line--__-- Total Length ----------------_--------- ' 'D' Box ------------ Type Filter Material; -------------------Depth Filter Material ---------------------------------•- ----- Distance to nearest: Well ------------------------ Foundation -------:---------------- Property Line. ---------- ------------- SEEPAGE PIT Depth --- Diameter -------- ------ Number --------------------------- Rock Filled Yes ❑ No WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well --------------------- .-Foundation _-----_--- ---------- Prop. Line __----------- ....... REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date ---------__-----------------------) Septic Tank (Specify Requirements) -------- ------- -----------------------------------------------------=------------------- -------•---------------------------- r p _ Di posal Field (Sp cify Requirements) - lC ---- � �. ------ - ` ----------------------------------------------------------------------_---------------•_--------------------------- (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: "1 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 Workman's Compensation laws of California." Signe ----------------- ----------------------------- ----------------------------------- Owner t BY Title '' If other than owner) ' FOR ARTMENT USE ONLY APPLICATION ACCEPTED BY ^; ----------, DATE ------------- --- -- --- ------------------------------------ BUILDINGPERMIT ISSUED ---- - --/ -----------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ----- -- '-----lk-- --------------------------- ------------------------- -----------------------=------ -------------------- ---- ----------------------------- -- -:--------=- - ---------------------------------------------------------------------------- --------------------------------------------------=------- Final Inspection b ---------------Date ---jr--=�3---'' f N JOAQUIN LOCAL HEALTH DISTRICT - - --- - -- - --- - - E. H. 9 1-'68 5M