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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---��--- - - --------- - - .- Permit (Complete in Triplicate) j ----- Rate 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/LOC ON ._ �- � `-- CENSUS TRACT -------------- ---------- -------------------------------------- Phone - ------ Owner's Name ,� Address �� -.-- - "_ re,E7 41-�,Ic --------.._. Cit -- --�- ------ Z Owner's - Y r.. Contractor's Name -------License # +. -��. Phone Installation will serve: ResidenceApartment House,❑ Commercial ❑Trailer Court ',❑ Motel ❑Other ------------- ------------------------------ Ile— Number of living units:-.-/_--- Number of bedrooms __Zr77�--Garbage Grinder ------------ Lot Size _ -/, -�5 -- Water Supply: Public System and name ------------------------------------------------------------------- ------Private Character of soil to a depth of 3 feet: Sand'❑ Silt[] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,El 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,] PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size---------------------------------------------.- Liquid Depth --------------------------- W1 Capacity ----------------- Type -------------------- Material---------------------- No. Compartments -- -:--_ 01 Distance to nearest: Well ------------------------------------Foundation -- ------------------- Prop. Line -------- ---:-------- ro } LEACHING LINE [ ] No. of Lines -----_/-------------- Length of each r . line_.- - th _- -- _--_ ---- -.-_-. �� Type Filter Material - x-_/- De th ?D' Box Filter Material ------Af- ---------------- Distance to nearest: Well --- _0 ------- Foundation -----, --.----- Property Line __------------ `6w i t SEEPAGE PIT [ ] Depth _445--------- Diameter --- er _.--.-.----_.-.--___�---- Rock Filled Yes g; No i❑ �.,��_.- Numb � ., Water Table Depth ------0------------------------------------Rock Size Distance to nearest: Well ----------------------------------------Foundation --------------____-- Prop. Line _.-_----....-----_-_ f. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------.---------------------------] Septic Tank (Specify Requirements) - -------------------------------------- ----------- Disposal Field (Specify Requirements) ------- !s ------------ ------------------------------------------------------------------------------------------------------------------ (Draw existing and required addition on reverse side) 1 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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that i performance of the work for which this permit is issued, I shat) not employ any person in such manna+ as to becomsu Iect t -W rkirari's Compensation laws of California." Signed ---- -, ----`"- -- - -- --- ---------- --------------- Owner - - ---------- Title (If other tha ed FOR D ARTMENT U ONLY APPLICATION ACCEPTED B ✓-- ------------- -- ------------------------- ---------- -'-------- DATE _ ® I BUILDING PERMIT ISSUED ----------------------- --------------DATE ADDITIONALCOMMENTS ---------- ----- •------------- --------------------------------------------------- --------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- ----------------- ------- ----------------- ------------------------------------------- ------------------------------------------I-------- --------------------------- ------ ----------- ------------------------------------- ------------------------------------- -- - ------ Final Inspection by Date -. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M