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FOR OFFICE USE: --- APPLICATION-------------- FOR SANITATION M.AIT ---------- ---------------------------------6 ' (Complete in Triplicate) Permi+ No: _"" This Permit Expires i Year From Date"lascre`�r ate Issued _1-__�q"_7I. 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION __ -X ? _/7�,: - __.___-_-CENSUS TRACT Owner's Name -.�---- - ---�� -f�--C��-�.--'-•- -- - -- ' -� �-----------4-Phone --------------•--------- F Address ------ r .---- - � ��--- - _..--------- �/� j 1 City a..�j-�'�el i/ - --------------------------------------------- Address -------------------- ---•-------------•--- Contractor's Name /~" -� j ... (� = r ---------- ------.License #IwAg l-- Phone E' f Installation will serve: ResidenceA Apartment Housei0 Commercial :[]Trailer Court D Motel C)Other.----------=--- -- - -- -----.. Number of living units---- ------ Number of bedrooms — I! -"."__"_._Garbage Grinder /_�.�__ Lot Size �_�",��"�_-_"_"•_"_"___ Water Supply: Public System and name � / c--- �r ----------------- " Private Character of soil to a depth of 3 feet: Sand [] Silt 0 Clay 0 Peat E] Sandy Loam C] Clay Loam Hardpan Adobe-E] Fill Material ---------- If yes,type ---------------------------- (Plot ___________________ ___" "(Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: {No septic tank or seepage pit permitted ifublic sewer is available able within 200 feet,l PACKAGE TREATMENT [ ] SEPTIC TANK f j Size ------_ "_ .-_" -------------- Liquid Depth ----- Capacity . C .. ------------- ------ Type ••---------------- Material---------------------- No. Compartments Distance to nearest: Well -------------------•--_-------=--_-_Foundation ---------------------- Prop. Line ---------. _-- LEACHING LINE [ I 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 0 Water Table Depth ----------- --- -----."Rock Size ------.----_-_- Distance to nearest: ------------------------------------ .WellFoundation --------------...... Prop. Line _. ..__-.-, - REPAIR/ADDITION{Prey. Sanitation Permit # -------------------------------------------- Date --------------•------------------_j Septic Tank (Specify Requirements, -------L_""";_____.. Disposal Field (Specify Requirements) _ -----------------------------------=---------- ------------------------------ ----------- ------ --------------------------------------------- ---- !--------------- (Draw existing and required addition on reverse side) 1 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 Rulesl 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 i- Owner By :------- ----- -----•--------------- Title----------- - (if of an owner) OR .D ENT USE ONLY APPLICATION ACCEPTED BY " -- f _ -" - DATE ". "_BUILDING PERMIT ISSUED ------" d � � ------------ ADD TIONAL COMMEN - -•----------• ----------------------------- ----=--------------DATE ---- ---------------------- . , - --- ------- - - ------------- -------------- -----------•- ---------- -------------------- -- -------- --- - - ------- ----- ---- ----- - --- ---------------------------------------------------------------------- ------------------------- / Final Inspection by: -"_-- _ ----- ----Date __-.-- --__~- -- _-- _ AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 R 5M