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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------- - -- - ----------=--------- - [Complete in Triplicate) Permit No.� l 1 711 --------- -------- 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: �_c;CJ ..� P//,� .- - -- JOB'ADDRESS/LO TI N a_ -4_ --------------------------------------z ' tea----��` ` CENSUS TRACT ° Owner's Name - re ✓_ ----- -------------------------------------------------- Phone ;IJ Address �i�c _- --- -------- City ---------------------------------- 00 , ------------ --- --- p Contractor's Name . l.. - s' r --License # f��a�� Phone -----------------••---------- Installation will serve: - Residence Et/Apartment House�❑ Commercial :❑Trailer Court l❑ }} Motel ❑ Other -------------------------------------------- 1 Number of living units:_____/----- Number of bedrooms ': _____Garbage Grinder ____________ Lot Size __._Lt-_ 6------------ I s Water Supply: Public System and name`-------------------------------------------------- ------ ---------------------------------------------Private [ Character of soil to a depth of 3 feet: Sand'El Silt❑ 'Clay ❑ Peat Sandy Loam -❑ Clay Loam ❑ I Hardpan E] _ Adobe ❑ Fill Material ____t_____ If yes,Type _________________________ __ 0 (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,) ��` f PACKAGE TREATMENT [ ] SEPTIC TANK![� Size-- ----"---.�9_"�-'°�----------------- Liquid Depth i`"_----------------------- CapacityaType _l - "" Material- No. Compartments ___lod c _._.___:____ Distance to nearest: Well ---- S-d----------------------Foundation -----f?---------- Prop. Line ---5_.------------- LEACHING LINE [7r No. of Lines ------�------ ,."_ Length�of.each line--------- a------ Tata! Length __l a__�______-__ 'D' Box _q-------- Type Filter Materia! :�,�t�_'_____--.Depth Filter 'Material ----rf----------------_----------------- Distance to nearest: Well _______&__/_/__ -- Foundation __---1-_Q'___________ Property Line __�---------- SEEPAGE PIT [ ] Depth ___________________ Diameter----------------- Number ---------------------------- Rock Filled Yes ❑ No ,i0 Water Table Depth ----------------------:r"" ---------------------Rock Size -------------------------------- Distance to nearest: Well ------------'---------------------------Foundation --------------- ---- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit r# _._t--..-------'-------------------------- Date ---------------.------------------) Septic Tank (Specify Requirements) -------------------------- - ---------------------------------- - ------ --- ---------------------_--•- Disposal Field (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 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." k' BY --------------------------------- ---- ---------------- Title _._ --- '� Signed ------------------------ Owner (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___-- ---� ----------------------- DATE --- `------~----/----- BUILDING PERMIT ISSUED ----------------------------------------------------------- -----------------------------------------DATE ------ -------------------------•--------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------- --------•------------------ - ------------------------------------ ---- i --------------------- FinalInspection by. ' ' - - --- - -------------------------------------------------------------------Date -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M