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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 4�-------------------- (Complete in Triplicate) j 1-7 ------ ------------ ------ - 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/LOCA ON ---- - _ _ CENSUS TRACT - - --------------------------------------------- - -- ------------------------ r" Owner's Name -Phone - Address -- %_ - fVlj-- �� 1`� = City �� !4`r / Contractor's Name --- ---t-ClqIF-5;;"- 1e--------------------------License #, c3_lZJ-_"Phone -F,2S- Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ',❑ Motel ❑ Other -------------- ---------------------------- Number of living units:-_- ----- Number of bedrooms __:�___-.Garbage Grinder -.- ____---- Lot Size _._________-_--_------------------------- Water Supply: Public System and name ----------- ------------ -----------------------------------------------------------------•---------Private e Character of soil to a depth of 3 feet: Sand P Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay 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.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT € SEPTIC TANK'[ ----------- --- ----------------- Liquid Depth ---------------------.----- Capacity ------------------ Type ----------- -- ----- Material-- ------------------- No. Compartments ------•---- ---------- ----------------- Distance to .nearest: Well -------- ------------------------ --Foundation ----------------- Prop. Line ------ f LEACHING LINE; ,[ ] No. of Lines ---------------------------- ngth of eac ine___---____---------------- Total Length _ 'D' Sox _____--- Type Filter aterial ------- -----------Depth Filter Material ------------------------------------------ Distance _________________ _-___-_-___--.---_Distance to nearest: Wel ______________________ _ Foundation ------------------------- Property Line_ ___-_._-_---__-_-_.-.__. SEEPAGE PIT [ ] Depth ___i-_______________ iameter --------- ------ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Dept ----------------------- ------------------------Rock Size ------------------------- ----- Distance to nea st: Well ---------- ----------------------------Foundation •-------------------- Prop. Line ----------- .......... I REPAIR/ADDITION(Prev. Sanitation P rmit# ------------- ----------------------------- Date ----------------------------------) SepticTank (Specify Requireme s) -------- ------ -----;----------- _----------------------------------------- -----------------------------------------------..---< ----------------•---------- t Disposal Fi 1 (Specify Re r meets) _____ __ _- - _ � �- �'�f r- - � ` raiz . ---------------------------- ---------- (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 Workma '-s Compensation laws of California." Signed Owner 56 Y _ -- - ----=-'7----- --- =.�-�----- — BY ------ - � �- ----------------- Title ------ ----- (If other than n�rner)-- � ----------------------------------------------------- (if - -------------------------------------------- FOR DEPARTMENT USE ONLY n APPLICATION ACCEPTED BY - ----- - -------- ---------------------. DATE ------ -.I3-'�` BUILDING PERMIT ISSUED ---------------------------------------------------------------- -------------L -----=----DATE ------------------------------------------- ADDITIONAL ----------------------- -- - ADDITIONALCOMMENTS -----------=------------------------------------------------------------------- -------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------------- ----------------------------------- Finai Inspection by: -- --':--------------------------------- - -------------------.Date ---- ------ 5AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.