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FOR OFFICE USE: 30 APPLICAUON FOR SANITATION PERMIT is .«'�.��.-(P�-___---_ /Q• iComplete in Triplicate] Permit No. _______________.____.__._ ----- 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---- --- %- U/,��/ CENSUS TRACT Owner's Name -- > .�'�3 C _Tl 7N--------------------------------------------------------------•- -- --------------Phone fM_P9_-1_,0'-.... Address - -- em --------W NZ9y1y4? ----- -------- --------- --- ----- -------- Ci#Y -57c, T --------------------------------._--._. .._ Contractor's ._._ - Name __.�A�5-----5_ 'T/-(----5«'u/7_Z ---------- ----------License # - _'_729--"_- Phone Installation will serve: Residence Z-Apartment House, Commercial :❑Trailer Court ;❑ Mote) ❑Other ------------------------------ Number of living units:._/-------- Number of bedrooms ______Garbage Grinder __ 43__ Lot Size 1_i_72a1_ S_-------------------- Water Supply: Public System and name ----------------------•---.......--------------------•-------............ -------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam .n Hardpan ❑ Adobe:g 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,) d PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -------------------------- (_Ii Capacity ---------------- --- Type -------------------- 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 ____________________Depth Filter Material ____________________ ........... Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line _-----------------.----- SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number ---_ _______________________ Rock Filled Yes ❑ No i[] Water Table Depth ------------------------------------------------hock Size ---------------------------•---- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------------.----- REPAIR./ADDITION;Prev. Sanitation Permit# -------------------------------------------- Date _______-_____.---.._____-___-___-) SepticTank {Specify Requirements) --------------------------------------------------------------------------------------------.-------------- -- --------------------------- Disposal Field (Specify Requirements) -0-10 -------------------------------------- -------------------------- 5 ------------------------ ---------------------------_____----_---- __________________________________________________________________-____._____._____.______-_-_---------------„---„___-________._________________________________ (Draw existing and required addition on reverse side) 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 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 ----- s — ------ --------------------- Owner BY -------- ---------------------- ------------- Title (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------------------------------------------------------- DATE ---�� b�--------------------- BUILDING PERMIT ISSUED --------------- ----------------------------------DATE ------------------------------------------- --------------------------------- -------------------- ADDITIONALCOMM KTS ----------�� - -- - ------------------------- -------------------------------------------------------------------------------- , y-- ---5-?-- -- 1- -------- --- - ---- - ---------------- ---- --------------- --------------------------------------------- ------------------ --- - ---------- ----------------------------------------------- - --- --------------------------- ----------------------------------------------------------- ---------- ----------------------- Final Inspection by: _- -Date SAN JOA QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. i