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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 4 ------- ----------- ------------------------------------ --------------- {Complete in Triplicate) Permit No. .�.�_1��- ---------- ------ 7� ^13 ----------------- This Permit Expires 1 Year From Date Issued Date Issued ----This Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: c A� 1J5`7 7 r c.� Dlt ° Y --CENSUS TRACT 'c,�� JOB ADDRESS/LOCATION ._-_.____ ___________ _ ___ Owner's Name Ct- ----------------=- ------------------Phone s�_""f_Tl Address ----,L.' �---------------------- CitY /1�-/�`� ---------------------------------------------- Contractor's Name --- tP-----------------------------------------License Yc39---------- Phone Installation will serve: Residence}Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:__________ Number of bedrooms ---------..-Garbage Grinder ------------ Lot Size Q —----------------- Water Supply: Public System and name --------------------------------•--------------------------- ----- •------------------------------------------Private a Character of soil to a depth of 3 feet: Sand� Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size--------------------------------------- ------- Liquid Depth ---------------._--------- o Capacity ----------- ------- Type -------------------- M erial--------------- ----- No. Compartments. ------------------ Distance to nearest: Well --------------------- -----------Found ion ---------------------- Prop. Line ---------------------- _J LEACHING --------- ------ LEACHING LINE [ ] No. of Lines ________________________ Length of ach line------ -------------------- Total Length -----------._______-______- J 'D' Box ------------ Type Filter Material --------------------D pth Filter Material --------------------.------------------------------- J Distance to nearest: Well ------------ --------.- Founda on ------------------------ Property Line. --------- ......... J SEEPAGE PIT [ Depth -------------------- Diameter ---------------- Nu erRock Filled Yes E] No ❑j' rn ---------------------------- WaterTable Depth ------------- -------------------------- -------Rock Size -------------------------------- EDistance to nearest: Well - -------------------------- ----------Foundation ------ Prop. Line ____.... .............v} REPAIR/ADDITION(Prev. Sanitation Permit# _____ -------------------------- --------- Date -------._____.__________________-_) , i Septic Tank (Specify Requirements) ____ ____ - Disposal F' Id (5 ecify Requiremenfis -------------------------------------------------- ----- - 64, ----------- a_ ` -0c,00 ------------------------------------------------------- --------------------------------------------------------------------------------- - (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 t War n's Compensation laws of California." Signed - ----- ----- - - - ---------------------- Owner BY -------- - --------------- ----- --------------------------- Title ------------------------ ----------------------------------------------- ----- --------------- I (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- 1 t n- ----------------- ----------------------------------------------------------- DATE ------'/---- -1-73------------ BUILDING PERMIT ISSUED --------- - ------ -----DATE -------------.------------------- __ ----------------------------------------------------------------------= -- ------ ADDITIONALCOMMENTS - - - ------- --------------- ------- ---------------------------------------------------------------------------------- --------------------------- ----------------------------------------- -- --•-------- ---- ---- -- ------ - -- ------------------------------------------------------------------------------------------- --------------- ------------ --- ----- ------ -- - - ------------------- - - -- ------- ---- -------------------------------------------------------------------- --------------------------------------- ---------------- ---------------- -- ----------------- ------------ -- = - ------------ - ---- -------- ' Inspection b . _ _ Date ---. "___ _"-_ �---------- Final SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M