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`, h '�; yi ,.;.. .,�.•. APPLICATION FOR SANITATION Pl— 'AIT - . ... ................. �~ Permit No. (Complete in Triplicate) 1111.__.....---... _1111..._..--- - 1111.-----=--- _ ---- ...... This Permit Expires 1 Year from Date Issued 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 is mad in compliance it County Ordinan No. 549 and existing Ru--s and Regulations: a vtvv r JOB ADDRESS/LOCATION - �. .. t. � �CSL � //a J .1.111.. .... CENSUS TRACT ... .�............... Owner's Name ..V......... .. . ........."..............._........ ....I.. . . ...., Phone Address 7 / �-�� City ... - .... ... ........................".-1111_. -� License # ( �? Phone t / Contractor's Name { [3Ya ......----.I...... (F .1. 1 ... _1111. Installation will serve: Residence ❑Apartment House fl Commercial ❑Trailer Court 0 Motel ❑Other . .—............................... - nn dumber of living units: . ..t1...... Number of bedrooms ..��......Garbage Grinder 11 11 ...... Lot Size ...y�1Ls�.. _ Water Supply: Public System and name ..............................................................................................................Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ 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: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK t ] Size... i_ .............._. Liquid Depth 1111. .._ Capacity -.j.,21- ._ Typed ......_. Material.. ..... No. Compartments. .. . 1111 .. . ........ Distance to nearest: Well ..f--(tl_L9--------...............Foundation ..... h.------... Prop. Line ...../ 6)* LEACHING LINE [ ] No. of Lines' :... _ .- Length of each line _. -- Total Length .... / ........... 'D' Box .(v��. Type Filter Material __... ._.Depth Filter Material ----- ............................ ...•-••-._........J Distance to.nearest: Well __ ._t ----------- Foundation ..... Property Line ...,f.0............. 6 SEEPAGE PIT [ ) Depth .,�P-...------- Diameter ................ Number ..._. ............ Rock Filled Yes ❑ No ❑ --) Water Table Depth -••-----....._•--•-••--------- ------Rock Size ... .! .---------------•--- fn Distance to nearest: Well ---------_..............................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permit# -------- ................................... Date ..................................) �f SepticTank (Specify Requirements) ...................................................................•---------••--•--....._..._..__._...----•---.._.__.........._....-. O` DisposalField (Specify Requirements) --•-- -----•------•---- ---•-•-•----------•..........:......... ...................................."-•-••••--••--.........._....-- ___ -- -- __ ----- --- ---------------- ---------- --------- ------------------- ---•----•--•--•-•-•---1.111--•--••-•-•----•----•---1.1.11._ S -------- ----•------------- ---------------------------------------- (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 Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 1b "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 .- __. -"other _ Owner BY C - �f ,� `C Title 1111 1. ._ .han�r ) F DEPA TMENT SE ONLY APPLICATION ACCEPTED BY__. _ ��___.._.......__._.____- DATE BUILDING PERMIT ISSUED . . .-. DATE . ........................................ 1111..-- -----11 •-•---••---"--•------"--------�---- -----•-•--••-•---1111-•-•- -- ADDITIONAL COMMENTS ......... ................................................. = ................................ ---------- ----------•-•--------------•---••------------•-------- -----•--------------•-•• -••....-----•---- '••-•---•-••--•-----•--•-----•------•-----....---•---- . .... -• -•------------•--•------- ----- -- ---------•- --• --- ------•---- •------•----._._....._...--------•-•--- ------. ...._..-•-•---•--------------- • ........................ ---- ------ - - ----- - - -- ---- ----• ------ Final Inspection by: . - 1 � ..................................... _._.......Date EH 13 211 1-68 liev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7II 3M