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I - - . --- ----FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Xomplete in Triplicate} Permit No- ---------- ----- ---------------------------------- --------- ------___ --------------------- This Permit Expires 1 Year From Date Issued Date Issued . ---- Application --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: f JOB ADDRESS/LOCATION .. ��----___ D / �G- -------------CENSUS TRACT ---------_---------------- Owner's Name ---��, ---- �11.��-��-�--- - --------------------------- ---------------- ---------- --Phone ----------------------------- Address City f Contractor's Name --.f_l� �_ --- S�j 71 -------S1� ------.License Phone ' ' ----- Installation Installation will serve: Residence IN Apartment House❑ Commercial ❑Trailer Court '❑ Motel ❑ Other -------------------------------------------- . Number of living units------�__--- Number of bedrooms ----/-----Garbage Grinder __111P- Lot Size __ -G��'/O�z- -------- Water Supply: Public System and name ------------------------------------ ---------___---___-_- _-----------Private ❑ ---------------------------------------------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,F] Clay Loam Hardpan ❑ Adobe ❑ 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,) PACKAGE TREATMENT { ] SEPTIC TANK'f Size_- �� - Liquid Depth - - ------- --------- Capaa city 06X�__ Type%!t' r - Material_4�P�l�No. Compartments -o�__ , } Distance to nearest: Well ---------- --- ' ----------------------Foundation ----��- ------- Prop. Line ---5`-----=-------- LEACHING LINE pQ No. of Lines -----/--------------- Length of each line---- 4---------- al . S -- TotLenth ------------- -- 'D' Box IV-0.---- T Type Filter Material -�oCl�___--Depth Filter Material -�-------------------------------- ----_____ _ ______________________ Distance to nearest: Well --- _,._------------- Foundation ----- - -------- Property Line -�---'--_ ----_____. SEEPAGE PIT ----- - _ Rock Filled Yeses] No .� !!! Water Table Depth -__ Q / I., " I p ---------= -------Rock Size --,'---X --------------- Distance to nearest: Well ---- --------------------------Foundation -- V? / - __-._ Prop. Line ....s--.--......... ' REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- ----------------------- bate ----------------------- Septic Tank (Specify Requirements) ----_---______________________ .. , Disposal Field (Specify Requirements) ---------------------------- - --------------------------------------------------------------------------- _ ------------------------- i, - raw 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 Rales 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/ blect to Workman's Compensation laws of California." Signed ----.. ` -------- - ------- - Owner BY ` - ----- -- ------ -------------------------------------- Title --------- - f� f the than owner) �/ FOR .DEPARTMENT USE ONLY BUILDING PERMIT ISSUED ----------� APPLICATION ACCEPTED BY ------ ------ DATE __._ _- -3.'__ _ --- - --------------------------------------------- ------------------------------ -------DATE ---- ------ --`---------------------------- ADDITIONAL COMMENTS -�-------------------------- --------------------------------------- f r _____: _:::__ __ r_ ______ _____________---_-:::::_______::::_---__-__::____ Final Inspection b �--------- ------ € ---------------- - �jy/V r ----------------------------- - ---------------Date .'�. ---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M j