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FOR OFFICE USE; `-7Q X q ---------------------------------------------- APPLICATION FOR SANITATION PERMIT Z� �%� (Complete in Triplicate) Permit No. .____._-______.__.../ This Permit Expires 1 Year From Date Issued + Date Issued �:_rG-_7.�1 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 madeincompliance with County Ordinance ,No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ------ (.�_---------------------CENSUS TRACT Owner's Name ------------ ------ hone �` --------- ------------------------------ -------------------- -- --- --- G��--- Address 7� City _Contractor's Name ------------- -' - --- ____-` ------License # - /.1------ Phone � ------ -- Installation will:se_ rve: *.Residence Apartment House❑ Commercial :❑Trailer Court I❑ `� 74 `x/ Motel ❑ Other ----------------------------------------- ' A r Number of living units: ------ _____ Number of bedrooms ___ ___Garbage Grinder _____ _ __1,pt Size ._.- ___ ____________-_.. Water Supply: Public System and name------------------------------------------------------------------- �;---------- -----Private ❑ Character of soil to a depth of 3 feet: , Sand'❑ Silt E] Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ %` F Hardpan ❑�' Adobe Fill Material ___________ If yes,aype____________________________ (Plot plan, showing `s,ize of lot,,locatior 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,) x PACKAGE TREATMENT [ I SEPTIGTANK f j Size -------------------------------------------------- Liquid Depth -------------- ._-,----- i, Capacity' - ., Type - Material---------------------- No. Compartments ------------------•--- O L D_istance,'to nearest: Well ...-------`'---------------- ,-__--Foundation ---------------------- Prop. Line ------------- ------ h LEACHING LINE [ ] No sof Lines'_________________._ Length of each line____-_______ _____ Total Length : 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----------- ------------------___-,--------- Distance to nearest: Well :_l-------------------- Foundation ------------------------ Property Line ------------------ SEEPAGE PIT PIT [ ] Depth ------------- <Diameter ______________ Rock Filled Yes ❑ No i❑ �. Water Table Ddj th------------------------------------------------ Rock Size ------------------------------ � ., t i Distance to nearest: Well ____---`--------- :.____'_,____Foundation -------------------- Prop. Line ___________ _________ REPAIR/ADDITION (Prev. Sanitation Permit'# ______ ______ ___________________------ Date ________-------__________________) t -- ---- --- Septic Tank;{Specify Requirements)_________ _---___-:----------------------------- . -_-- _ _ L� Gc..._.41 Disposal Field (Specify Requirements).:' -h- ------ ------,--- -- ``-- --------- ------------------------------------------------C�4-1 5 i I hereby certify that Ir have prepared th s application and required addition - _ (Draw existing and on reverse side) e 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 Workman's Compensation laws of California." Signed =— �� -------------------------------- Owner BYa- ---- ------ F ------------�--------------------- Title r a x✓ems .: { (if other t owner)'" FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ,`^ --------- '�----------------------------------------------------------------- -- DATE ---- - ------------------------------ ---------- BUILDING PERMIT ISSUED ------------------------------------------------------- --- ---------------------------------- DATE --------- --------- - ADDITIONALCOMMENTS ------------------ ------------------------ - ------ -------------------------------------- --- - ---------------------------•--------------------------- ---------------------------------------------------------------------------------------------------------------------------- -------------- ------------------------------------------------- -- ------------------- -` Final Inspection by; --- / Date - = G ----------------------- -------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev- 5M