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'FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- ------------- Permit No: --S ...•�_. (Complete in Triplicate].--------------------------------------------- ' Date Issued -----------------------------------------________________ This Permit Expires 1 Year From 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: JOB ADDRESS/LOCATION .__.�/,� /,_ :____. _ . ��--� ---------------------------------------- --------,CENSUS TRACT --------------•----------- Owner's Names�'f.� ._ i� ��-?X/ -0, -------- `��1, 1 frrV!d Phones - �fYA - Address __ City �" Tf------------------ i Contractor's Name ____ar -------------------------------License # JT W3--__ Phone Installation will serve. Residence ❑Apartment House,❑ Commercial ❑Trailer Court 0 Motel ❑ Other ------------------------------------------- i Number of living units:____- Number of bedrooms _---_____Garbage Grinder --�— ---- Lot Size _17 ,F __________________ E, Water Supply: Public System and name ---------------------- ---------------------------------------------------------------------------------------Privateer Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay-Loam .E] �.. Hard an Adobe Fill Material __-__.______ If es,type ________________________ ' P ❑ I� Y S. (Plot plan, showing size of lot, location of system in relation to- wells, buildings, etc. must be placed on reverse side.) k NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) L t # PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------------- ---- Liquid Depth ---------------------.-•-.. Capacity J------------------ Type -------------------- Material---------------------- No. Compartments ------------------ J. Distance to nearest: Well ------------------------------------Foundation --------- ------------ Prop. Line ---------------------- t LEACHING LINE [ ] No. of Lines ------------------------ Length of each line.--------------------------- Total Length ------------------- -------- V Box __ _------- Type Filter Material --------------------Depth Filter Material --------------------------------____. ----_- Distance to nearest: Well _______________________ Foundation ------------------------ Property Line- ____-____________--_--__ SEEPAGE PIT [ ] Depth ____ --------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No (3 Water Table Depth ------------ ----------------------------------Rock Size ------------------------- Distance to nearest: Well ______-- ----------------------------- -------- ----------- Prop. Line _____________-__--___. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ________________._______.___ --) i; SepticTank (Specify Requirements) ---------------------------------------------------------------------------------•----------------------------.•--------------------------- Dis osal Field (Specify Re uirements) r ix ----------------------------- --------------------------*------------------------------------------------------------------------------------------------------------------------------------------------- _f-------------------------------------------------------------------------------------------------------- ----- r F (Draw existing and required addition on reverse side) I hereby certify that 1 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 su ject to War an's Compensation laws of California." Signed --------- --------- ---------- -------------. Owner BY ---------; --,--------- ------------- Title ------------------------------------ ----------- ------ ---------------- (If er than owner) ARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ------- - ------------------------------------------------- DATE .------r=/i_7n7_/------------- BUILDING PERMIT ISSUED ---- ---=--------------DATE -------------•----------------------- ADDITIONAL COMMENTS _ -- --- -- i ------. . --------------------------------------------------------------------- ----------- -- -- ---------- --- --------------------------------------------------------------------------------------•---- -------------------------------------- ------- ---- ----- - -- Final Inspection by- ------------ ---- ------- -------------.Date r ..................... AN. AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68,Rev. �"Ae