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'FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- E (Complete in Triplicate) Permit No. INhis Permit Expires 1 Year From Date Issued Date Issued .�'_�._-7L 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/LOCATION . j'��1 y------• , ��Git,1C---------------- -------------- -----------------CENSUS TRACT`-----------------..-_.---- Owner's Name ,c.- �--------------------------------------- ---------- Phone i� -` � J� 1 Address ------- ------- - _ �._ ��=�_._ -"�=-y�-=-- ---._.--•--. City ,.� __c?_,.�_ _�7--------------------------------------------- Contractor's ---- - ------- Contractor's Name :' _L_(?t_ ..K_C cd�'^,.___ ._ _ _C�C------td- ci- ____.License # _-144��__ Phone Installation will serve: Residence A Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑Other Number of living units:-__,/----- Number of bedrooms _ ___.Garbage Grinder Lot Size ___ _.____C�.�__--___._ Water Supply: Public System and name ________________-_-__----_--_--___-_ I-------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe;0 Fill Material -_._.-- ---- If yes,type ___________________________ (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 P0 Size.__ �,�---may �,r- ✓ -- - --- - �{ __._.._.__ Liquid Depth -----4-oc"'fi CapacityType ------ Material_.Lc< . No. Compartments .....,__ •---- Distance to nearest: Well ___ -- "° Foundation ...... -------- Prop. Line .___ ............... LEACHING LINE No. of Lines ________1-- _g d� . _.._____ Length of each line___... _��_.-..____ Total Length-- - ______..�_________....._._. 'D' Box - ---_ Type-Filter Material ___-_- .��___Depth :Filter Material __.___../_ � _ _ �___' ____ _________ j � Distance to nearest: Well _. �_---_.--______ Foundation ----�D------------- Property Line ....„,�e_.__.._..._ SEEPAGE PIT Depth -----t2.1:_'`__ Diameter _?3`-- Number __-___:�_' _ _ __ _____ Rock Filled Yes No Water Table Depth ------------ - �- -----------------------Rock Size ------�------- --•-------•--- Distance to nearest: Well -------1A0_.�------------- Foundation -_- �__r-_.____ Prop. Line ...... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------^�l-_ -----_-----_-: Date ------._ .............. Septic Tank (Specify Requirements) ---------.----------------------------------------------------- Disposal _______.__________-____------_--------------Disposal Field (Specify Requirements) _________________ ----------- --------------------------------------------•------------------------------- - - ---------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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.” Signed _ . g -- - -- B (If other than owner► ---- -- -- - ---- --------- Owner --- --- Title ______ - � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -____. DATE ___ .'__ - -------------- ------- ---- --- --- --- -- --- -- ----------------------- BUILDING PERMIT ISSUED -- --------------DATE -------- --- ADDITIONAL COMMENTS _____________ __ -- ------- - - ---------------------------------------------------- -- -5---------4)----------- _F _ ---- -------------------------------- ,�'� �. -- } ----- ------- ---- - - ------------------------------------------------------------------------------------------------------ ---- -------- ------ - --- --------------------------------- ----- -- --- - - - --- - __ --------------------------------------------------- Final Inspection by: Q_Y ✓ --------------------------------------------- Date - - -- - -- ---- Final JO QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ��/�