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FOR OFFICE.USE: APPLICATION FOR SANITATION PERMIT ------ ----_- _ . Permit-No. (Complete in Triplicate) Date Issued -_�Z- :-7--•- __ ----------_-_ This Permit Expires 1 Year From Date Issued l 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 compliance with County Ordinance No. 549 and existing Rulei and Regulations: JOB ADDRESS/LOCATION --------- `p CENSUS TRACT --------------•-------•--- Owner's Name _r �Q_ ----------------•----------------------_-------------------------------------Phone - - - -". IQ� • - - --------- ------------ Address / i�r�ly1/------------------------ City .Ca--------:----------------- --------------- ..� Phorae Contractor's Name -nc�--_License # . ✓�=- - G.2C Installation will serve: ResidenceApartment House❑ Commercial ❑Trailer Court C] Motel ❑Other ------------------------------------------- - ; Number of living units:-.--- -_-!`Number of bedrooms -__3-----Garbage Grinder ------------ Lot Size -_�6�__ ___-- QO__.-.---•---- Watdr Supply: Public System and name ------- _�_---_----__-__ Private - Character of soil to a depth of 3 feet: Sand'❑4;' Silt[:] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan'❑--Adobe-❑ Fill Material __------ If yes, type ---------------------------- (Plot -------------_-____-----(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,) I PACKAGE TREATMENT f ] SEPTIC TANK.f ] - ? Size------------------------------------------------ Liquid Depth ---------------- ------ R Capacity _146-6------- TYRe P�s.t1'� Material__-_ o. Compartments ____ ..;...------ : Distance to nearest: Weil ----, ----------------------Foundation -----1d------------ Prop. Line ----✓----- _------ LEACHING LINE No. of Lines -- --.__.Length of each line------P.0------------ Total Length ---------- -------------- � � a 'D' Box .-- Type Filter Material __1-Y'40p Depth Filter Material -------- -------•--•----------------- ' Foundation -__-�----------------- Property Line -S_---------------- Distar5ce to nearest: Well� dO J_____----------=- SEEPAGE PIT ( ] Depth -------------------- Diameter ---------------7 Number ---------------------------- Rock Filled Yes ❑ No 0 i. Water Table Depth 1 Rock Size i ------Foundation -------------------- Prop. Line -----.....___---- . Distance to nearest: Well '_._.,,:-__-„ .,.�--------------_ • --- s REPAIR/ADDITION{Prev. Sanitation Permit# __________________------------------------�__Date ---------------------------------- i ------------------ Septic Tank (Specify Requirements) --------I------j--------- ------------------------------- -------------------------------------- Disposal Field (Specify Requirements) -------------- - ----------- ------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- -------------------- ------------------------------------------ jDraw 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 shall 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 APPLICATION ACCEPTED BY --------------- -fin (_-: .tnr: - DATE = '------------------ ----------------------------------------------------------- --- BUILDING PERMIT ISSUED -------------- ---- ---------------- -------DATE ------------------------------------ ADDITIONAL COMMENTS --------------------------------- ------------------------------------------------ -- -------------------------------------------------------•---------------- ------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- ---------- ---------- -------- --- ----------------------------- -------------- -----------------------------------------------------------------------------------------------<- � ------- = Final Ins ec#ion b _'�_''"3 -. -----------------------Date ----�------------------------- -------------- p y- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M