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�-FCsR bFFICE USE: _ -� :�<�•��'� _. _ APPLICATION FOR'SANITATION PERMIT ------------------------------- /l _. (Complete in Triplicate) Permit No: Q This Permit Expires 1 Year From Date Issued Date Issued/r),,96-_70 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 Rules and Regulations. JOB ADDRESS/LOCATION ------------------- CENSUS TRACT - -- - --------------- Owner's Name .. --- - ------ -- -----=--------- ------------=----------- ......Phone J _Z - i _� Address -- -- - ---_`_ ._ _. GtY �r Contractor's Name .---_--.__- _- ____.License # - �1 `7 Phone t Installation will serve: ResidenceApartment House❑ Commercial :❑Trailet Court !,❑ f Motel ❑ Other --------------------------------------------- Number of living units._-)------- Number off bedd_r000mms ________Garbage Grinder ,--_-_4___ Lot Size ._ _f --------------- Water E Water Supply: Public System and name --------- ------ -r------------------------------------------------------Private ❑ . Character of soil to a depth of 3 feet: Sand'M f Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ____________ If yes,type ---------------------------- \ (Phot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V\ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) `fin F PACKAGE TREATMENT [ ] SEPTIC TANK f Size---- -_QL---,Z�_„�X-------------------- Liquid Depth ----- _________________ Capacity ----- Type ------- Material---- ------ - o. Compartments --- ______________ Distance to nearest: Well __________ ____________-------------- Foundation ....A0----------- Prop. Line __ ____-_ ._.-- ff: LEACHING LINE No. omaLIYe _______-2--_______.__ Length of each lin_e__--- ��----�------ Total Length------- ---- --f-- --------V -1,0VD Depth i Filter, Material �A-....----------- ------------•- Distance � to nearest. Well - ------------.-.--- --_ .Foundation -----l®__----------- Property Line ----- t_________---- SEEPAGE PIT [`] -,:.y Depth ---------_ Diameter, `-- --------------- Rock Filled Yes .;` No i❑ 4 <- ��-._-- Number --____-- -- _ k[ Water Table Depth ' ------- f Distance to nearest: Well`________________________, --_-----_Foundation __.� ___-__.____ Prop. Line ------ .____________ I 1 REPAIR/ADDITION(Prev. Sanitation Permit# ------- ----------------------------------- Date ---------------------------.------I Septic Tank (Specify Requirements) ___ -------- ____ _ •--------' Disposal Field (Specify Requirements) --------------------------------------------------------- - -------- --------------------------------- - - - - --------- - ----------------------------------------- ------------------------ --------------------------------------------------- -------------=----- -------------------------------------------- - t t i (Draw existing and,required addition on reverse side) I hereby certify that I have prepared this application and 4hatkthe 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 w_ hich this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.” ` ( j Signed -------------------- �' --------. Owner BY r� Title - --- ----- -- --------- --------- ----------------------- (If other tha owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED, BY V .___r___ -- p DATE r)712------------------------------- 4 6-r 7-------------------- BUILDING PERMITISSl3ED - 1��t�" =-----°`_'-'1 s�'l� DATE :_ ADDITIONAL COM NQS G - -------------+----------------------------------------------------------------------------------- � - /--- -:: ------------------------------------------ - ------ - ----- - -----------------------------------------------------------------------------------------------------=------------------------------- Final Inspection b -- - --- - ------Date --- d y `-7o ------ ' SAJOAQUIN LOCAL HEALTH DISTRICT GG>� E. H. 9 1-'68 Rev. 5M