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FQR'UAFt"ECE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) Z V Date Issued ---- -----------------_--_-----:-----__--------------_ This Permit Expires 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: JOB ADDRESS/LOC TION -/P-600----6--------57' ` � i -------------CENSUS 'TRACT ------- ------------- Owner's Name -----------------------------=-=--------------- ---Phone ------------------- Address $ C I __ 0�.._ `'` / 1znc J . city X�k�1 --------------------------------------------- ! Contractor's Name License ---- Phone -� - -- ( .__._C�ollll --------------------------------------- Installation will serve: Residence {F Apartment House❑ Commercial❑Trailer Court Motel ❑Other ------------------------------------- ----- Number of living units:------ -_-. Number of bedrooms __�---___-Garbage Grinder _.---------- Lot Size __._ __ s------ Water Supply: Public System and name -------------------------------------- ------------------------------------------------------------------------Private w Character of soil to a depth of 3 feet: Sand's Silt ❑ .n 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,{ ] Size-------------------------------- ------------- ' Liquid Depth -------------------- -.----- Capacity - ------------------ Ty/ee --- ------------ Material------------ - - o. Compartments-- ---------------•------ 0 Distance to nearest: W -- -----------------------------Foundati - ---- ---------- Prop. Line ----------- ----------- LEACHING LINE [ ] No. of lines ------------------ ngth of each line-------------- - ---- Total Length ---.-------.------_--------- k D' Box ------------ Type Filaterial ____________________Depth Fiaterial -------------------- -----------_---------- Distance to nearest: Wel ____________ ____ Foundation ._.____ _.-. Property Line _______.---______----_- SEEPAGE PIT [ ) Depth ----_______________ Dia ------_________ Number ----.______ __-------- Rock FilledYes ❑ NoWater Table Depth ------- -------------------------------Rock Size --------------------------- Distance to nearest: Well --------------------------------Foundati ------ Prop. LineREPAIR/ADDITION(Prev. Sanitation Permit# ------ ----------------------------- Date ------- --------------------Septic Tank (Specify Requirements) ------------------- ----------------------------------------------------- ------- - - ------- ------------------- Disposal Field (Specify Requirements) ---4-dd---------��-------- ------- -------- ------------------------------------------ ------------- --- - -- ----------------------------------------------------------------------------------------------------------------------- ----------------- {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: i I "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 -`-- -- BY ------- t ` ------------------------------- Title ------ -------------------------- --------- -------- -------- E (If other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ - ___-✓ ----------r-. DATE --.6_ -'��---------------------- -- - - - - ----------------------------------------------------- - BUILDING PERMIT ISSUED ----:--- --------------------------- --------------------------- ---------------------- -------DATE ADDITIONALCOMMENTS ---------------------------- ------------------- ----------------------------------------------- --------------------------- -------------I--- -- ------------------------------------------------------------------------------- ------------------------------------------------- ----------------------I--------- ----------------------------------------- - - --- ------------ ----- ------- Final Inspection by. Date — " Zl ti SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M