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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Z -3-33 ---------------- ---------------- -- - _ _ Permit No. -------- (Complete in Triplicate)- " _:-'__ _________________________ This Permit Expires 1 Year From Date Issued Hate Issued Application is 4eby 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•an_d,existing Rules and Regulations: i ..+// i / JOB ADDRESS/LOC�ATpIO�N_ - - _ lP �.-- `{[-fix*-c.� .-_---- CENSUS TRACT -------- -.-,--------------- Owner's Name / c�---- ---- -------- - - -------- •-------•--------------------------------- -------------------Phone Address ---- --------- ----- - ------------------------------------ City ------------------------------------------- Contractor's Name ______ _____ ,GrP}v_v .License ._ Phone6-- -►2_-Al_r_9A 4 Installation will serve: Residence ((Apartment House ❑ Commercial.❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number -- ------------------------------Number of living units:_________ Number of bedrooms _________Garbage Grinder __________ Lot Size ___.� Q_ _ ._P-6________ Water Supply: Public Sy-s ----- - - Character of soil to a depth of 3 feet:` Sand!'Cl Silt❑ Clay ❑ r Peat❑ Sandy Loam ❑ Clay Loam t4 i Hardpan L�i Adobe ❑ Fill Material ------------ If yes, type ____________________________ (Plot plan, showing size of lot,,location.of.• ystem 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 { j SEPTIC TANK'[ j Size--- ______-c__-_____ __________ Liquid Depth _______________:__ ---------- ---- ------ Capacity ,�7�06_--.-__'Type -Q �__=_ Material_ _.___ __. __ No. Compartments ___ ____._..____ r Distance to nearest: Well --- 6b'_____ __ ___________Foundation ____1_a____________ Prop. Line ----s-- '--______ LEACHING LINE No. of Lines ____ �_____________ Total Length "________ [ ] �--------------- Length of each line----�� -- g � •r D' Box .___ Type Filter Material _�!? Depth Filter Material ------ ________________________�.------ I Distance to nearest: Well ---�_�©---_______ Foundation-.__-E;U__=r-_r::-Property Line _____�______________ SEEPAGE PIT ,[ ] Depth -------------------- Diameter ________________ Number ------ Rock Filled Yes ❑ No C] _Water Table Depth ----------------------------- ------ -----------Rock Size -------------------------------- t Distance to nearest: Well --------------------------- - ----------Foundation ---_.-__--- - • -------------------- Prop. Line ---------- --------_-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------- ----------- ...... Septic Tank (Specify,Requirements) ------------------------------------------------------------------------------ DisposalField (Specify Requirements) ------------------------•--•-------------------------- ------------------------------------------------------------------------------ ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------_------------------------ F ------------------------------------------------_---__________________________ __ (Draw 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: "I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------ �----- -----------------------------------------------------------•------------- Owner BY �` --------------------------- Title ------- ---- - ------------------------------------------------------- �' (If other than owner} FOR DEPARTMENT USE ONLY Q APPLICATION ACCEPTED BY --------- 052 - ------------------------------------------------------ DATE ------- -' --- ----------- BUILDING PERMIT ISSUED --- ------------------------------DATE ADDITIONAL COMMENTS - --�� -� -� � ----------------------------------------------------------------------- ----------------- ---------------------------------------------------------------- -------------------------------- - -----------------------------------------------------------------------------------------'------------------------------------------------------------------------------------------------------------- ----------------------------- - - --- - ------------------------------------------ ------------- --- ------------ - - - --------------------------------------------- - Final Inspection by Date ��- �'� J :SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M