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FOR OFFICE usE: APPLICATION FOR SANITATION PERMIT ------------------------------------- ------------------- _ Pe t rmit No: e� - - - ...:,--- .,,(Complete in Triplicat01._"_ - --------------------------------------------------------- Dale 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 j described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION . S+-"_./O ' ------ -- ---CENSUS TRACT --------------•----------- �� 40rei Owner's Name ---AI�-------e.......... i /rS ' ------------------------- ----------------- --------------Phone Address e-.w Cit Pd?� ----.-- --------------- Contractor's Name .��---�---lfK��..�-��'�------ -�-- •License # --��-�'�-f`-- Phone ___--__ Installation will serve: Residence�KApartment House❑ Commercial ❑Trailer Court F] ] FMotel ❑ Other -------------------------------------------- } Number of living units:---(------- Number of edrooms __� ____Garbage Grinder _____________ Lot Size 'O_�X__ 00-------_- i Water Supply: Public System and name �'[lrlt.�------------------- -------------=----------------------------------Private ❑ .Character of soil to a depth of 3 feet: Sand'❑ Silt'❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam E] ' Hardpan ❑ Adobe Fill Material"__- If yes, type --- f__-_-_______---- (Plot plan, showing size of lot, location ofdsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or p seepage pit permitted if public sewer is available within 200 feet,) r/ - PACKAGE TREATMENT [ ] SEPTIC TANK'{ ] Size_____�X_7-- _------------------ ---- Liquid •Depth _��---------------- LJ M 2L Capacity --� Type p __ Material____ __________`_____ No. Compdrtments --___.__.-:__-. i Distance to nearest: Well ------------------------------------Foundation ---1 ---=Prop. Line _____-�____:__--____ _ f LEACHING LINE [ ] No, of Lines -----X,-�----- Length of each line----/ /-7�`Total Length .-__ -----/_76- i 'D' Box ---2-.--- Type filter Material _�p_64---Depth Filter Material ____le_______________________________ Distance.'to nearest: Well ________________________ Foundation ------------------------ Property. Line_ _.______---_______-----_ SEEPAGE PIT [ ] Depth ___/ -_. R_ Diameter _%.? --_____ Number ______. ______________ Rock Filled Yes No 0 Water Table Depth ------------------------------------ -----------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line __ ......... REPAIR./ADDITION(Prev. Sanitation Permit ------------------------------------------ Date ---------------------------------.1 Septic Tank (Specify Requirements) —r - ---------------------------- ----------------------------- ------------------------- -------------- Disposal Field (Specify Requirements) __ _r__`_=____ ` , ----------- --------------------- - ------------------------ ---- --- ------------------------------ ------------------------------- - ° k I (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 California." ' r _ 6 Signe --- ----------------- Owner ----- I - --------------------------------------------------- Title ----- --- ----------------------------------- If other than owner) F PARTMENT USE ONLY t ' APPLICATION ACCEPTED BY ___-_ _ j_ __ DATE ---__ �- x--71------------ -'------- ------=------------- - -------------------------- - - BUILDING PERMIT ISSUED - - --------- ------------------ ---------------------------------------------DATE ADDITIONAL COMMENTS ------ -- _ . ------*- -'=-'s---- < ----------------------- -------------- ----------------------------------- ---------------------------------- --- Final Inspection b `� - --------------------------•-- ---------r_..---------------- Date j SAN JOAQII� IN LOCAL HEALTH DISTRICT_- i E. H. 9 11-'68 Rev. 5M