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FOR OFFICE USE: APPLICATION` FOR SANITATION PERMIT - f ------ *)------------ �' ^. Permit No. ------'---------- -� (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued _____:"_�__-...__. ---------------------------------------------------------- Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: -- -- __- --------- -.-_CENSUS TRACT ..--/_- JOB ADDRESS/LOCATION,__ -- __ �- �-- -�-�-- 770 Owner's Name t ---------------------------- ------------- -Phon Address ---------------- - -- ------------ -------•--- City e - _, Contractor's Name ________________ _____ _ __ #- - ' __.-_-____--.License # Cell___ Phone_=960 Installation will serve: Residence-'44 ApartmentDouse❑ Commercial ❑Trailer Court ;❑ Motel ❑ Otfier�______.E________-- Number of living units..---/---- Number of bedrooms __�__ arbage Grrind rte_ :______-_ Lot Size ____�QQ_�--Z��____----___- ` r Water Supply: Public System and name-------------------------------- -_ _4t ..L.� Private ❑ 41 1 Character of soil to a depth of 3 feet: Sand'E] Siltj] Clay ❑J Peat-E] ' Sandy Loam ❑ Clay Loam ❑ r �. � Hardpan ❑ Adobe.X Fill Material _____----- Yestype _________________________ i Y �rY f (Plot plan, showing size of lot, location of-systernr-,inr.relation to wells buildings, etc, must#be placed on reverse side.) NEW INSTALLATION: (No septic tankor seepage,pit permitted '+f public sewer its available within 200 feet,) ar .�.PACKAGE TREATMENT [ ] SEPTICTANK.''[�]=�� Size------------------------------------------------ Liquid Depth ------------------_-,-.- Capacity ---------- ---- --- Type ___ .r '°_ Material----------------�NoCom.partments -.--------------- =---- Distance to nearest. Well __ ________________________Foundation ___ ---------------___ Prop. Line ____---.______________ \44_,"f77_ 1 LEACHING LINE { ] No. of Lines ___ _______ RLength of each line---- . "f 7_ Total Length ____---____,_______________ 'D' Box -----------7 Type Filter Mdterial --------------------Depth'�+ilter Material -------------------------------------------- v _ I Distance to nearest: Well ________ --------------- Foundation ______"r________r______ Property Line __-_____________•-_.-_. SEEPAGE PIT [ ] Depth -------___-- ------ Diameter Number -------------------- --- Rock Filled Yes C] No 0Water Table Depth --------------------------------------- --------Rock Size --------------------------------- Distance to nearest: Wel! -------------------------- Foundati4 on--<•___-_______ ______ Prop. Line __._.__...____._____-_ i REPAIR/ADDITION{Prev. Sanitation Permit# ------------------ ___-_____-__________ Date ___________ __I_______I..______) Septic Tank (Specify Requirements) I I -..n- --------------- ------------ t Disposal Field (Specify Requirements) ---- - --------- ---------- ----- - ----- ------------ [�L l r "d E_ I -------------------------------------------------------- ---------- i------------------------------------------------- --------------------------------------------------------- {Draw existinghand 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--JoaquinwLocal IHealth'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 Compensation laws�of California." ! i Signed ---------- ------------------ f -----------------= Owner BY - -------- Title --------- r (If other n owner) PARTMENT USE ONLY APPLICATION ACCEPTED BY - ` '.- � :---------------- DATE �.�J ¢----------------- BUILDINGPERMIT ISSUED --------- --------------------------------------------------------` _ ------DATE ------------------------------------------- ADDITIONAL ------_-- _ -�-- _ - ADDITIONAL COMMENTS ----- --- ------------------------------------------------ -------------------------=--------------------------- -------------------------------------- - -- - ----- ---= - ---------------------------------------------------------------------- ----------------------- y- ---------------- Final Inspection by- ----- -- --- --- ---------------------Date f---------� N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M