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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7� �� ............ ................_............ Permit No. .. ..................... {Complete in Triplicate) ......................................................... This Permit Expires 1 Year From bate issued Date Issued ................. ....................... ............... ....r...�.... ... Application is hereby made to the San-:loagvih 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 .�%Q/6 ...*,V"j'�rr-'._��_.�lI.._.....-� . ...... . .... ................CENSUS TRACT .......................... Owner's Nome .............. -----------...............,•.----------.-. . - --------------------Phone ................................... Address .. - .. Cit Contractor's Name .. ./ -1 ,��,/10—-----------------------------------------License #+271'x. _- ... Phone !�la.5-'.�K/...... Installation will serve: Residence Apartment House❑ Commercial [3Trailer Court Motel ❑ Other . ...... • --. -• ---- -------------- Number of living units:.. �_.... Number of bedrooms __- __._Garbage Grinder/ a... . tot Size Water Supply: Public System and name . ...............------------------------... ..------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Cloy Peat❑ Sandy loam;E] Clay Loom ❑ - .,-------'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 T ] Size-----................3..... ..........•-- -- -..._ Liquid Depth ...................._-.. Rs w Capacity Type --------- ------ --- Material No.No. Compartments ---- ................. Distance--to 'n-earest: Wel __ ............................Foundation .............. Prop. tine ....__- ............. LEACHING LINE [ ] No of Lines length of each line i .. ....... .... Total Length ............................ 'D' Box ..... Type Filter Material --------------------Depth Filter Material ..................... ..................... Distance to nearest: Well,�---------------------- Foundation ,. `"...----- Property Line ........................ SEEPAGE PIF [ } Depth _ Diameter ................ Number . ...... .._. --------. Rock Filled Yes ❑ No [] Water Table Depth ------------ --•---. -------.Rock Distance to nearest: Well .,_....-•-------------------------------Foundation ........ . ....... Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation-Permit# -------- ---- -------------------_----- Date _,._-..-,---1.___..__.._____.-----) Septic Tank (Specify Requirements) . . . . ... ._... ...=:: ----1-------------------------------- - ------ ------....._.--------- Dis osol Field (Specify Requirements) ---�( -•- tel.. y li..... G/ „ .. J21'r /� 1��1�. r w 1:....... ....------.. .. ------------- .. ..................... (Drdw 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: 'P "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 ---- --- 5 -------------•-- Owner 13y .... ..... -------------- •---.. ... Title 40f 'l.. of er than owner _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY X.... .. . .. •--- ... _ .... ._. DATE .... . . BUILDING PERMIT ISSUED .... .. �.- ... .......... ---------....................... .. ... .. .. ...........DATE . . ..................................... ADDITIONAL COMMENTS ........___--------- ............................... ... ...........................-----... ------.... ....-----._......-. _.,.:..-- -----. ...................................... = = --- Final inspection by: ----------------------------- -•----------•- .......................... . �.. .-. .. ................ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H, 13 24 1.'68 Rev. 5M _ 7/723 ,1,4