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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...- `... Permit No: {Cemplehin Triplicate) .._......... ............... Date Issued ..........:----•--- This Permit Expires i Year From Data 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LCKATI _S_`f_�.`L.----�✓:. .._9.2.... . .. '..-----...CENSUS TRACT ------------..........--- Owner's Nome ....... ................Phone ................................... Address -----------.......cn-v .....................- ----------------------.._City -`•kft-�5 ............ ..... .......-........_................. Contractor's Name - - l ee - - ... . License /r�y 3el!>'-... Phone .............................. Installation will serve: Residence Apartment House Cl Commercial❑Trailer Court ;❑ IMotel ❑Other ............................................ Number of living units:___. I Number of bedrooms -.,3.......Garbage Grinder ... w- Lot Size 1 ii_E'S'fr................ ------ ---- Water Supply: Public System acid name .-•-........ ......---.._..--- -- --------- - -----------------.-Private Character of soil to a depth of 3 feet: Sand It❑i Clay ❑ Peat❑ Sandy Loam ❑ Cloy Loom 71 e Hardpan [ Adobi❑ 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.) p NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 7, PACKAGE TREATMENT [ ] SEPTICTANKT ] Size..........................................._... Liquid Depth __---..--..------.,..-- Capacity1 T e .----t-----------. Material------------ -------- No. Compartments _......... Distance to nearest: Well -------------- -- ----- -------•---Foundation -..----------------- Prop. Line ............... \ LEACHING LINE [ ] No. of Lines ............__......... Length of each line Total Length 'D' Box --------- Type Filter Material --------------------D•epth Filter Material ----- ..._................_......._..... Distariceito nearest: Well ........................ Foundation...:..................... Property Line ........................ SEEPAGE PIT [ 1 Depth ............ -- Diameter ................ Number .._.__... ..ii----------.... Rock Filled Yes ❑ No (] Water Table Depth Rock Size/....................... o nearest: ....--.......... Distance,tWell `..:• _Foundation .... .............. Prop. Line i .--.---- It REPAIR/ADDITION(Prev. Sanitation Permit# .................------------------------- Date : ------- Septic Tank (Specify,Requirements) --------------------------------------------------- - " ~ ------------------ ................. Disposal Field (Specify Requirements) ----47-11 .......1...-------�-�------/-r-�'-`-5---.. ''�`-••- -.....--........ -----------------------------'--------------...._......---'•----- _......- ---------------------................-....... .1 --------------------------------------'..:... -- (Draw existing and required addition on reverse side) I hereby certify that Ihave 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of Califomio2' :� Signed ..._.� _. ._------- - --- Owner - --- -- --,�, .--••-- -- --- - - ---........------ .. Title .-- ----- (if other than ownei) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._ ,- i - DATE - 9- . BUILDING PERMIT ISSUED ............. DATE ...................----------------•-•••-- ADDITIONAL COMMENTS - ----------------- ........ ._-------_...__.._.. ...... _....----... _..------` ------------'- ...................._+•--•--.....------------....---...... --- y Final Inspection by: _ -------------------------- ---..Date/-...._._ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M