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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,.. .�:. Permit No. -------------------------.--,-r------------------ -0-- _-_-�-----�---U----- (Complete in Triplicate) =----------- ---------- ---- - (,7;69Date Issued This Permit Expires -- w 1 Year From Date 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: 6 ¢. 3 _-- �Il�t fl IF_ .,G_4 C US TRACT -------------------------- �0 -3 r� JOB ADDRESS/LOCATION . " ne ------------------------------------ Owner s Name jC --------------------------------------- - - Pho .� -� _I _ Address _ O --- --• 11�f- I - _ _ - - 6 _ 1` ----- ----- .` _ 'Contractor's Name _. =� al?!?_1/ F-----------------•--' License . r S2- _�:�--- -- Phone --- ---- - Installation will,serve: Residence y Apartment House-E] Commercial ❑Trailer Court :❑ Motel ❑ Other --------------=----------------------------- Number of living units:______ ___ Number of bedrooms :_____Garbage Grinder ------------ Lot Size F a Water Supply: Public Systerri and name ---------------------- ----------------------------------------------------------------Private`1)� Character of soil to a.depth of 3 feet: Sand g Siff❑ Clay ❑ Peat❑ Sandy Loam -❑ .. 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.I ] Size f----------------------------------------------- Liquid Depth ------- Capacity ------ Ca acit -� No. Compartmentsi-------_----------- -_ "---,-- TYPe /V -- P Material � Distance to nearest: Well ---s7- -------------------------Foundation __1- --`_______-___ Prop. Line ---�3�r__.:..------ z LEACHING LINE { j No. of Lines ___-.�--------------- Length of each line--_____16-0---__.__ -- Total Length ____2" .------- —Box' —"."-"------Type Filter Material _-�4��I4r -_____Depth Filter Material ----��-____------------------......... Distance to nearest: Well -----SJR- --------- Foundation ---f------------------- Property Line. ---_-.--------------- SEEPAGE PIT [ ] Depth --- Diameter ________________ Number ---------------------------- Rock Filled Yes (] No 0 WaterTable Depth ------------------------------------------------Rock Size ----------------------- -------- Distance to nearest: Well ----------------------- - - Foundation -------------------- Prop. Line ----------•----------- I - - REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------- :---- Date ----------------------------------) Septic Tank (Specify Requirements),_-'--------------------------------------------------------------------------------------- ------------- ------------------:---------- --------------------------- I Disposcil Field' (Specify Requirements) ------------- --------------------------------------------------- ----- ------------------ ------------------ ----------------------------------- ----------------- - I (Draw existing and required addition on reverse side) I hereby.certifrV 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: "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 ompensatton laws of California." Signed _.___ F Owner ------------ BY -------- ------ Title ------------ ---- -------=------------------------------------------ f (If other than owner) f FOR DEPARTMENT USE ONLY _ r APPLICATION ACCEPTED BY DATE --- � � ~�`3��9r�---------- - ------------- ----- - ------------------------ ----------- BUILDING PERMIT ISSUED -------------------- ------------- - ----DATE ADDITIONAL COMMENTS -------------------- --- ---------------------------- --------------------- ----- i -------------------------------------------------- -------------------------------------------- ----------------------- ---- --=---------------------------------------------------------------------- ----------------------------------- --------------- ------------� p Y- ---- - ur+ f - Date � '�% Final Inspection b -- I� ------ -------s-------- ---------.---"--------_-_-------: SAN JOAQUIN LOCAL- HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M