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FOR OFFICE USE: OPPLICATION FOR SANITATION PE T i Permit No: ---�1--- -•--------- .� ------• (Complete in Triplicate) --------------------------------•----------------- ______________ 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 irc�o�myp�liance with County Ordinance No. 549 and existing Rules and Regulations: a�e in JOB ADDRESS/LOCATION AId----------------------------CENSUS TRACT --------------.-.---=----- �,, ` - ----------------------------------------Phone Owner's Name _._ J1.{ -— - �l -Ci - `. Address --. V�_- 'rte` ----------------- -------------- -f City Contractor's Name --- - n1L4: -.License # _;24 :._ _JPhone -- .---.- Installation will serve: Residence [gApartment House[] Commercial :❑Trailer Court ;❑ Motel ❑Other ----------------------------------------- --- .Number of living units------------- Number of bedrooms _--` __Garbage Grinder __2Zen�ap Lot Size __.-__--_-.-----_------_-.-.-_--_.._-.__-_- Water Supply: Public System and name ------------- -------- --•----------.--------------------------------------------------------------------------Private f Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat E] Sandy Loam ElClay Loam ❑ Hardpan ❑ Adobe- ] Fill Material ------------ If yes,type ---------------------------- i (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK;j:+]�' Size.... _�'- _--_.� ---------- Liquid Depth ----------------- -------- f Capacity 1.2Qa-------- Type -- Material- ✓-- No. Compartments --- ------------- MDistance to nearest: Well - + __________ __________Foundation _-� `- Prop. Line -��` --- ------ Length of each li-ne----- --�--------------- Total Length,-/Z/d--.------------ LEACHING LINE [ ] No, of.Lines ------sZ- g �- - i 8'�._ D' Box --j._.---. Type Filter Material * epth Filter Material --- ------- --- f ----------- i Distance;to nearest: Well ------ ____- -- : Foundation -------- ---------- Property Line --- .............. - Diameter _:-- Number _---:-___---------_ - Rock Filled Yes 1P No 4 SEEPAGE PIT [ ] Depth �-__ --- _. - .. Wa#er' Table Depth -------•---------•----- !tock Size --•-------- -•- Distance to nearest: Well -----------------'--------=------------ Foundation -------------------- Prop. Line ----------............ REPAIR/ADDITION(Prev.'Sanitation Permit# ------------------------'------------------- Date __--------------------------------) Septic Tank (Specify:Requirements) ---------------•--- - - w-.-_-_---- 5 posal Field {Specify Requirements) _____________ s Dis •---------•------------------------------ -� _ _ ------------------------- hereby cerci that I .save prepared existing and required addition on reverse side) I d 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 ---------------- Owner---- - BY t. � ------ Title 1 (If other fiha owner) { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY !9_r -------- DATE ----- ^'t' 8 �7r--------------- I ,3UILDING PERMIT ISSUED ---------------------------------- --------------•---------- ------------------------------=------- DATE _ ADDITIONAL COMMENTS ----------------- - ----------------------------------- -------- 1 f� PV--------0-(?-------�.-f�-11'�� ---------------------------- --- --------------------------------- ----------------------------- -- ----------------------------------------------------------------------------------------------------------------- ' - = ------------- ------------------ ------- --------------- ----- � -`r " I Final Inspection by: -------- -G- �V7-------- --- ------ - -- � -•----------- ---------------- ---- -------- Date - = i SAN JOAQUIN LOCAL HEALTH DISTRICT 4� E. H. 9 1-'68 Rev. 5M