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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT --------------------- ------ ------------------- .-7-.�.- �.. -- -- -------------- (Complete in Triplicate) Permit No: This P rmit Ex 1 Year From Date 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 comfiance with County Ordinance No. 5.49 and existing RuleO,and Regulations: JOB ADDRESS/LOCAT N ---------------------- - CE US TRACT ----- U 7.._.-._.-.. Owner's Name ------ c-,--------- -----------Phone Address =` ------ ----- -- - -- ----------------- City ----------- -------------------- Contractor's Name -------- -- --- --- ----- - ---------;--------License #oZ_1; VJV V-!__ Phone , J;.L-L?t Installation will serve: Residence Apartment House,[ -'Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- Number ------------------------- ----------------Number of living units:----l_---- Number of bedrooms ..-----Garbage Grinder 41"' ___ Lot Size I Water Supply: Public System and name ------ -----------------------------------------------------Private ❑ CharacteFbf'soil to a depth of 3 feet: Sand'❑ "'"Silt❑ 1?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 CaPacitj�! f_�if��TYPe/� . Material_, _ .. No. Compartments ..___________________ � r ` Distance to nearest: Well _ �... ..............___Foundation -��-`.-...-'Prop. Line ---1=V l......... V LEACHING LINE No. of-Lines -----, ------------- Length of each; line___s �..__--------- Total Length .�....._... - 'D' Box ----f----- Type Filter Material /lP�...._._Depth Filter Material -1,$F.._._..___.-._.__..`___........ j Distance to nearest: Well ---------- Foundation __ZQ'_------------- Property-Line :- -------------_ SEEPAGE PIT �e}' Depth` -aI'7_------ Diameter -W-7-------- Number -----____eP---------------- Rock Filled Yes X No i❑ Water k Table Depth --------$Ih�---------------------- '� ...Rock Size ---- ----------------- ' mi Distance to nearest: Well -----�6- ----------------------Foundation __�Q_.--- Prop. Line _Cl------------- REPAIR/ADDITION(Prev.,Sanitation Permit# -------- ----------------------------------- Date ----------------------------------- ,.-Septic __-------.__....._.._.:._.._._-,.-Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- --------------------_--- �. Disposal Field (Specify Requirements) ,------------------ ------------------------------------------------------- i ----------------------° -------------------------------------------- ------------ ------------------------ --------------- ----------------------------------------------------------------------- ------------------------------- --------- --------------- -------------------------- --------------- -------- _ - — (Draw existing and required addition on reverse side)' I hereby certify-that) 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 ollowing:."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 y (If other than owner) tf FOR DEPARTMENT USE ONLY BUILDING PERMIT ISSUED -----------•-- - ------ - ------- --- - - ------ -"- ----- ----------- -- ---• DATE __�.`.��-------------------- APPLICATION ACCEPTED BY .... a- ------------------------------------------------- ------ �}}// / DATE -------------------------- ADDITIONAL COMMENTS ----- .�a -- ��--- --- {-�t � � �� r � - �j'�,kJ `-C... -- / -- --- - .. _�--.-.-.- _.-- "---_"__ - -- - -_.Y - - - ..._.�-.��z__.--.. -..__... _ --- ' .. Date --------- ------------------ .-.....-....------......-..._.-------_.--------. Fina] fns ection by ---- -------------------------- I14i I I '-- - SAN JOAQUIN LOCAL.'HEALTH DISTRICT- -� ' E. H. 9 1-'68 Rev. 5M