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' FOR OFFICE USE: , A5 77U ��-� Q APPLICATION FOR-SANITATION PERMIT (Complete in Triplicate) Permit No. ----------•---- ----------------------------------------- This Permit Expires 1 Year From bate Issued 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/LOCATION .5"Gvl��`✓IL-_!fp------'Y-`-` - ---- i „ -t. C�---------------.----------CENSUS TRACT --------------•---------_ Owner's Name ------ ----------------- -------------------- ----------Phone ------ Address .--------2iCPG - City0V6__ .ears Contractor's Name ._ L, �- ------------------------------ ------------------License #Pe J,5__4 Phone Installation will serve: Residence 1K Apartment House❑ Commercial :❑Trailer Court Motel ❑Other --------------------------------------••---- Number of living units:---- Number of bedrooms ________Garbage Grinder ___/____ Lot Size ------------------------- Water Supply. Public System and Aame ------------------------------------ ---------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam j& 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,) NJ PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size__6X.6:1*.A " "_"" ___ _ Liquid Depth .___ 1A Capacity /Ve---" Type BZ��_< 5/_ Material______________________ No. Compartments --------- ....... Distance to nearest: Well ---6_v-`=--------------------• Foundation _/4Q_________ __-_ Prop. Line '�J r :. LEACHING LINE No. of Lines _! [ ] f�l f l� Length of each line---------------------------- Total Length l�X -- ------------ - -- D' Box _4 --- Type Filter Material 1 _Depth Filter Material .__ y Distance to nearest: Well ------------------------ Foundation ------------------ ----- Property Line SEEPAGE PIT [ ] Depth _______________ ____ Diameter ---------------- Number _.------- ------------------ Rock Filled Yes [3 No C] i Water Table Depth ------------------------------------------------Rock Size ----------------------------- i Distance to nearest: Well ----------------------------------------Foundation ------------------- Prop. Line --------__------ REPAIR/ADDITION(Prev. Sanitation`:Permit# ---------.----------------------------------- Date ----_---_-------•_""-- } Septic Tank (Specify Requirements) -------- ---------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ------_------------------------- ------------------------ ____________________ ------------------------------------------------------------------------------ ---- ------------------------------------------------------------------------------- ----------------------- ----------------------- --------------------------------- ---------------------------------- f(Draw existing and required addition on reverse side) I hereby certify that 1 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, dome owner or licen- sed agents signature certifies the following: a "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 subje t to Workman's'Compensation laws of California." Signed y ------------- ------------------------------------ Owner BY ------------------------------ --------------- ------------------------ Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- DATE f` '?' -------------- BUILDING PERMIT ISSUED -------------------- ---------------DATE ---------- ADDITIONAL COMMENTS - --------- ---------------------------------------------------- -------------------------------------- ---------------------------------------------------- t f Final Inspection by: - ` -- ------ ------------------------------ Date . --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M