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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �' Permit No. �--Z--�-�•�°- (Complete in Triplicate) ------- - ------------------------------------- Date Issued �+ w This Permit Expires 1-Year From 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: JOB ADDRESS/LOCATION --Iii/..... � / T��.... � ENSUS TRACT Phone C�------------------------------- Owner's Name _.-__ - Address --- - �f�J1 .2`-/ ----------------------------------- City License # 715f-3--- Phone.4(A964'--3AP- Contractor's Name ---_ T�/ f11� -.�� -------------- ------ - Installation will serve: Residence Apartment House'❑ Commercial ❑Trailer Court i❑ .y m8tel'o Other`.y-------------------------------- --•---- Number of living units;---!_------ Number of bedrooms -______Garbage Grinder A10--- Lot Size I --------Private 'J�l Water Supply:..Public System and name ------------ ------------ -----------=------------------------------ Character of s I to a depth of 3 feet: Sand Silt❑ Clay�❑ Peat❑ Sandy1oam ❑ `Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ____________________________ Q (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r,- y E NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) f1 4 �� SEPTIC TANK [ ] Size--------.5`3--X-j`X- - -------.--Liquid Depth -----` ......--•------- PACKAGE TREATMENT. [ ] f W _ Material_ .� No. Compartments ------4-1 Capacity / f�- Type < 0- r Distance to nearest: Wel[ ______ -------------- --------Foundation - -A10---------- Prop. Line LEACHING LINE I [ ] No. of Lines ---- -------------- Length of each line------- ___ Total Length .f p -- Type Depth Filter Material ____�c{�___-______------ --•------- -= 1�t `D' Box __ a Filter Material !_�X_%__--- p � � _ ' Foundation Q-------------- Property Line. __- ------------••----• t Distance to nearest: Well __�--_________ SEEPAGE PIT [ ] Depth ---------- ------ ____ Diameter ---------------- Number ------ Rock Filled Yes ❑ No i❑ - 1 •� - Water Table'Depth{ Roc Size -------------------------------- Distance to nearest: Well -------------------- --------Foundation -------------------- Prop. Line ---------------------- ------------ S REPAIRfADDITION(Prev. Sanitation Permit# -..°---- ----------------------------------- ate ----------=' W :. Septic Tank (Specify Requirements) ------------------- --- ------------.•------- Disposal Field (Specify Requirements) ------------- ---------- ----------------------------•--- ---------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 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 ject to Workman' Compensation laws of California." `�9— �j Signed ------- U------------------- Owner --- - --------------- ------------- Title _ ------ ------ By --------------- ---- (If other than owner) FOR DEPART ME T USE ONLY APPLICATION ACCEPTED BY _------------------ -- - �------- DATE BUILDING PERMIT ISSUED -------- ---------- -----------------DATE ------- ------------------------------------------ ADDITIONALCOMMENTS --------------------------------------- -----------------•------------- ------------------------------------------------------- ----- ---- -- -------- ----------------------------------------------------------------------------------------------------------------------------- 7 Final Inspection b ----------Date ----?--' ---------------------- f SAN JOAQUIN LOCAL HEALT14 DISTRICT CT2r F_ H_ 9 1-'68 Rev. 5M