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FOR OFFICE USE: —APPLICATION FOR SANITATION PE.-...iT / Permit No. ._ --- -------------- - -- ------- -- (Complete in Triplicate) - - - ------ ------- - Date Issued = .......1��. 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION `�- 4 ��r S L ` �� - - - - CENSUS TRACT ---3-7.......... Name .-� .Y I rn E 5-- _Y�.4ti -------••------------------ ---------------------------- Phone Address oZ.3 3 e ..S_v__N------------------------ --- City S \O-C_�Tv-'V --- -------------------- Contractor's Namex \�.'I _V`� �- �0 4� --------------------License # .O-Vd ---- Phone Installation will serve: Residence Apartment House ❑ Commercial []Trailer Court ❑ �o'b� V�o.vie� Motel ❑ Other -------------------------------------------- Number of living units:- _ ------- Number of bedrooms --_�-_---Garbage Grinder ------------ Lot Size ----------- ------------------------------- Water Supply: Public System and name _________________________ -----------------------------------------------------Private IR Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam X 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 ?ACKAGE TREATMENT [ ] SEPTIC TANK [`]/ Size----------------------------------------------- Liquid Depth ---------- --------------- 6 Capacity .1PLO -------- Type t � _-- Material._�cT(iC?�Q No. � ----?=------------- ompartments 9b,-,r Distance to nearest: Well ---------._�1..�'_U------------------Foundation -------- ------- Prop. Line ----__________________ i _EACHING LINE [ ] No. of Lines ---.-__s�.__..___--_ Length of each line--._-_-.-�4�____.__.___ Total Length -----i1�0-___--_-__-- 'D' Box -.--_----. - Type Filter Material ___.Q4�-�i".___Depth Filter/Material --------- ----------------------r------ Distance to nearest: Well .--._2LQ�.._... Foundation ----_�� '-- -- Property Liner' r f Depth - - -------- - ----- Diameter Number --- ---------------- ----_ Rock Filled Yes ❑ No ❑ Water Table Depth -------------------------------------Rock Size -------------------- ------- Distance to nearest: Well ----------------------------------------Foundation -----....... --- Prop. Line -.-.--__________------ - REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------- ---- Date ----------------------------------) Septic Tank (Specify Requirements) -._--.-___-___ ------------- Disposal Field (Specify Requirements) -----------------------------------•-----•----------------------- ------------------------------ ---------------------------------- -- ------- -- - - - - - ---------------------------------------------------------------------------------------- ------------------- --------------- ----- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work twill 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 br5infm subj Workman's Compen�ption laws of California." --Signed 01 •......�L - - Owner - - ----- --- ---------------- Title ----- ---. - ----- --- ------------- By (If other than owner) FOR DEFARTMENT USE ONLY APPLICATION ACCEPTED BY ___-__--. --__----._-__.____-_. DATE __-- -2 -2 BUILDING PERMIT ISSUED -- --•----------•-------------------••----------------------- ------- DATE -----•- ----------------------- ADDITIONAL COMMENTS ------------ ----••---------------------•------ -------------------------------------- •------------- •--------•--------•------- ----- ------------- - Z _ ::a \�,, -tom - ---`-- Date _,3' Final Inspection by: --•-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M