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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------------------------- --•- Permit No: .__�o__�-f.3 (Complete in Triplicate] ---------=----------------------------------------•----- --.-------_- 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 . 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -------��1--��[,�-A_Z1 7a- eu6ar-__ ----------------------CENSUS TRACT Owner's Name /� 0__y---------------------------- ------------ ---------------- ---Phone ------------------------------------ Address --------------- ------------- ------------ Cit ---------------------------------------------•------ Contractor's Name -------�r-;;re-7_'� Cfd__I_ -----------------------License #/411 ,PZPX-__ Phone .1� . �►��i Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court I❑ Motel ❑ Other -- ------------------------------ Number of living units:----l--____ Number of bedrooms - ------Garbage Grinder._ Lot Size �'+ . .................... Water Supply: Public System and name ------------------------------------ PrivateA Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe EJ Fill Material ------------ If yes,type ------------------ --------- (Plat 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_ [ I SEPTIC TANK [ ] Size------------------------------------------- ---- Liquid Depth --------------------.----- Capacity ------------------=- Type -------------------- Material---------------------- No. Compartments ------------- •------- Q Distance to nearest: Well ._'________________________________Foundation ---------------------- Prop. Line ---------............. �} LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length --------------.-----_---_-__ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------.------__--_---_-•-_-_._ . Distance to nearest: Well ----- -- '---------- Foundation ------------------------ Property Line ------.____-._.-__._..-_ SEEPAGE PIT ] Depth ------------ ------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ---------------------- --------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------. REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- - Date ----------------- ___I Septic Tank (Specify Requirements) ----------•- 4p sX rf Disposal Field (Specify Requirements) -------- _�-___ ..5�-� 6k t-�f.�, 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 Cal' ornia." Signed --- --- ----------------------------------------------- ---- ------------ - Owner By ----------- � Title -------L1'7`---t - ------------------------------------ (if other than owner) s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- --------------------------------- DATE `' .------------------- ` BUILDING PERMIT ISSUED ------- -------------------------------- ---------------------------------------DATE ---- -------------------------------------- ADDITIONAL COMMENTS - --------------------------------------------------------------------- -----------------------------------------------------i--- - --- ----- -- ----------------------- -=-- Final Inspectionby: -------------------Date,f.f 7- ---- -- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev'5Mt*�