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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------------- Permit No. (Complete in Triplicate) i ---------=-----------------------=----------------------- / — / - This Permit Expires 1 Year From Date Issued Date Issued ... 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 incompliancewith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ./� �.____"�` - 2--` ------CENSUS TRACT _.___.___._____-_ __ ---:-�-- - ------------------------------------ Owner's Name ------------ - - __-----~ ------,------------------------------- -------Phone ------------------------------------ Address `'L f - ---------- ----- Cit . y G` - -� f Contractor's Name _.__ __ ------------ # Phone _________________ Installation will serve: Resi ce [ Apartment House❑ Commercial ❑Trailer Court ;❑ k Motel ❑ Other ------------------------------------------- 1 Number of living units;------- Number of bedrooms _53------Garbage Grinder ------------ Lot Size ------------------------ __________________ Water Supply: Public System and name ----------------- -------------------------------------------------------------------------------------------Private L`r Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam - lay,Loam :❑ Hardpan ❑ Adobe ❑ Fill Material .------------ If yes,type ------------------------___ . I (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 f ] SEPTIC TANK:[ ] Size________________________________________________ Liquid Depth .___--------_____________- Capacity -------------------- Type -------------------- Material------- No. Compartments ----------------.:.... Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line __-______:_____.___._ LEACHING LINE [ ] No. of Lines -----'------------------- Length -of each line--------- -----------.-__ Total Length ______-__-.___-___________- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --- ---------------------------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line SEEPAGE PIT [ ] Depth ____________________ Diameter ______________ Number ---------------------------- Rock Filled Yes .Q No i❑� Water Fable DepthF - - - -�-- - C Distance to nearest: Well -----------------_------------------------Foundation -------------------- Prop. Line _.________-------- G REPAIIR/ADDITION(Prev. Sanitation Permit# --'------------------------------------------ Date ----,---------------------------- ) rr Septic Tank (Specify.Requirements) --------------= ---------- f ==----------------------------------------------- -Disposal = ---- .....................-- ------ Disposal Field (Specify Requirementsp __________ - .--- +r-_ --- -- `"!` ------ ----- t-------------------�------`--fJ------ ' - ' - (Draw existing an`d 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. Dome 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 ampensation laws of California." -- n Signed --------------------------------- ---------- -- ------ Owner —. , ---------- `��Title �- BY -------- (If other than owner) =-"FOR-DEPARTMENT" USE ONLY`— APPLICATION ACCEPTED BY ..--- -E' -- ------------------------------------------- DATE -------------- BUILDING PERMIT ISSUED --------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------ ----- --------------------- ------- ------ --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - ------------- . ------- --- ----------------------------------- ------ -- - -------------------------------------- Final Inspection b _ Date ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M r