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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------- (Complete in Triplicate) Permit No. -------- -- ------- --------------------------------- q (L4- - 3 ------------------------------------- - _-.---------_-- This Permit Expires 1 Year From bate Issued Date Issued __._[_ _._____ .. Application is hereby made to the San Joaquin Local Health District for a per 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 .--- - -:--------- -_- _. I__/ J_'----------------------------CENSUS TRACT --- ------ V Name /----------°--------- --.1 -- --------�11��--------��-, �2/9NC�- -------------Phone ----------------------•- •--------- 1!Y �/ _/2 � City /1I�IN �G _ Address ----------------- -- --- --- - -----------------• ---•------ --- - --- ---- -- --- - Contractor's Name _._. --------------------------------License # V T-�-7---- Phone _ 23:7G A p-,Y' ' Installation will serve: Residence K Apartment House�❑ Commercial ❑Trailer Court l❑ Motel ❑Other -------------------------------------------- { Number of living units:------- Number of bedrooms __....Garbage Grinder _.---------- Lot Size _________________________________________ k l Water Supply: Public System and name ------------------------------------ -- -----------------------------•---------------------------------------Private t' Character of soil to a depth of 3 feet: Sand�V, Silt❑ Clay ❑ . Peat ❑ Sandy Loam ❑ Clay Loam ❑ ' Hardpan ❑ Adobe ❑ Fill Material __________ If yes,type ____________________________ E (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK' Size---------------45'X-_b_X ---- Liquid Depth _ 24, Capacity ----- Type /r-,2-f,4v40r, Material---5XO-?' No. Compartments -Z................ 0 istance to nearest: Well ---------s�Q/--------------Foundation ..__ ------- Prop. Line --d --.--....._. 0 00 LEACHING LINE �o. of Lines ---- 3----_______- Length of each line---,,7r-- Total Length o�d_r---------------- 'D' Box __--------- Type Filter Material RP ______Depth Filter Material --/,9- ----------------------- Distance to nearest: Well --------- Foundation ---1-6--------------- Property Line A-6-------------------- I% SEEPAGE PIT [ ] Depth ___--_______________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ Na . _ r WaterTable Depth ------------------------------------------------Rock Size --------------------------..---- Distance to nearest: Well ----------------------------------------Foundation ---------------_.---- Prop. Line --------------- ...... I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ---------------------------------Se tic Tank (Specify Requirements) ---------------------------------------- --------------------------- ----------------------------..--------------------------- Disposal Field (Specify Requirements) ----------- ---------------------------------------------------------------------------------------------------------------- j: __ ... ------------------------------------------------------- -- ------------------------------------------- ---------------------- ---'-- ------ ---- -------- ---------------- m ( (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 I. as to become subject to Workman's Compensation laws of California." Signed Owner BY ........ Title (If other than owner)!! 1 FOR DEPARTMENT USE ONLY � a APPLICATION ACCEPTED BY -------7-7-9-!q--------------------------------------------------------------------------- DATE --------- BUILDING PERMIT ISSUED -----------1------------------------------------------------------------------------------- --------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------- -'.----------------------- ---------------------------------------------------------------------------------------------•------------------ --- ----------------------- ---- ---1-------- ---- --- ------------------------ ------------------------------------------------------------------------------------ - ----------- --- -------------------- ---------- --------------------------------- -- --- ` --- - ----------------- 1 Fina! Inspec by. -----•----------------------------------------Date --� / ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M