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4 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT F� - ---=------------------- -- -------------' � (Complete in Triplicate) Permit No: ..--------------�-- --------- ----- , This Permit Expires 1 Year From Date Issued Date Issued _ -------------- Application "7- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein F described. This application is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .___ 1_f I_.l .---— -�+`--- - --------- -------- ------CENSUS TRACT J ,, l Owner's Name _ /� `,I = - �R�► -�� { ` .--------------Phone Address - 1- /-l � F --- --•--. City - J �- ---------- ., ` Contractor's Name ll ---------------------------------- 4(3 License # l - Phone 7_ _ Installation will serve: Residence ❑ Apartment House❑ Commercial [-]Trailer Court ;❑ Motel ❑Other Number of living units:..-L- Number of bedrooms __�-----Garbage Grinder ------------ Lot Size _ff� l�_ f 1 Water Supply: Public System and name ------------------------------------ -••----------------_--- - --___--Private -------------------------------- a� Character of soil to a depth of 3 feet: Sandi Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ _C_lay Loam Hardpan ❑ Adobe.E] 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 [ ] SEPTC TANK'[ ] Size Liquid Depth ---------------- rr Capacity - -- ------------ Type --------- ------ Materia ----- ---------------- No. Compartments 1 Distance to nearest: Well ----------------- ------------------F undation ---------------------- Prop. Line _.....---- __..._.. LEACHING LINE [ f No. of Lines --:_-_------ --------- Lengt of each iin - -- Total Length __________ k ---- -------- -�-,. ;D' Box ----f-------- Type Filter Mater' I --------- - Depth Filter Material ------ - -----------------------------•--•- Distance to nearest: Well____..__ ------------- Fo dation -._-.------__-_---_-_-- Property Line ---__----..______._.-,. SEEPAGE PIT [ ] " Depth -------------------- Diameter _________-----. umber ------ --------------------- Rock Filled Yes [] No i❑ i Water Table Depth ------------- ------------------- --•--------Rock Size - t Distance to nearest: Well --- -------------------- ----_-------Foundation --------:----------- Prop. Line _.---------------- REPAIR/ADDITION(Prev. Sanitation Permit# __-____ __________________________________ Date Septic Tank (Specify Require_ments) -------------------------------------------------------------------------- -------- -----�r------- Disposal Fi Id (Specify Requitements) --------------------------------------------------------------------- - _ _ —_S 3.a Wt oc- -. ire - � _ _________ __________ -------------------- ---- ___________ ------ -------------------- (Draw existing and required addition on reverse side) f 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 foliowing: "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 __-- -F-- -o------ Owner ------------------------------- - r[� ; BY -------- . l ----------------------------- Title ------------------ (If other than owner) �rJ FOR DEPARTMENT USE ONLY ` 'APPLICATION ACCEPTED BY .--- =` - --------- ------------ ---------------------------------------- -- DATE --- � -�� _ - BUILDING PERMIT ISSUED -------------- ---------------------------------------------------- -------DATE ------------------------ ---------------------------- NAL COMMENTS - ----- - - --------------------------------------------- ------ ------------------------------ --------- - -- -- ---------------------------------------------------------------------------------------- - -------------------"_---__----- ----------- ------'---------`---------------- ------------.--------_-_-._--_----- ------•-----__ - ------------ . - ----------------- _---___--__ _-- __ _-.- __.._______._______ Final Inspection - --------------------Date --- s --- ---- -------- ----- ------ - - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT e E. H. 9 1-'68 Rev. SM