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.� FOR OFFICE�USI : APPLICATION FOR SANITATION PERMIT -� _/'7.- _d-J Permit No. - ��-7-- ------- ---------- U F 'j` ------ {Oomplete in Triplicate) ----------------------- Date Issued - -::-/? This Permit Expires 1 Year From Date Issued d ,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: -:> lifi CENSUS TRACT -------------- ------- JOB ADDRESS/LOCATION --- QI - ------------------ ----- ------ - Owner's Name ! ' Phone Address --------- -mw--• ----------------------------------------------- City ------;----------------------------------,------------------------------•-- Contractor's Name - --- 'A–CA---- --------------License # J�2<� Phone - Installation will serve: ,� 'Residence ❑Apartme sef-j Commercial :❑Trailer Court i. Motel Other - --- --------------------- - - - Number of living unit - I --__ Numlaer of bedro --Garbage Grinder -- Lot Size ------- -- --- -U--- -------------. Water Supply: Public System an.name ------------� - --------------------- Private ❑ Character of soil to a depth of 3 feet: + Sand❑ Silt El Clay E] Peat E] Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobes[i�'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, C NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------- _--- ------ Liquid Depth -------------------------- Capacity -------------------- Type -------------------- Material---------R- -------- No. Compartments Distance to nearest: Well -----------------------------------Foundation---------------------- Prop. Line ---------------------- µ:Vi LEACHING LINE [ ] No, of Lines ------------------ --- Length of each line---._____-----------___--- Total Length _.------------- ------------ 'D' Box ------------ Type Filter Mate ial --------------------Depth Filter Material --------------------•------------------------ i Distance to nearest: Well " ---_ Foundation --------------------.--- Property Line_ ---------.---- S£EPAGE PIT [ ] Depth ------------------- Diameter --!- ------ Number -------_-----------_-_--_- Rock Filled Yes ❑ . .No 0 i Water Table Depth --;.-------------Rock Size -.------------------------------ _, x k Distance to nearest: Well ------------------- --------------------Foundation -------------------- Prop. Line _-------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------•- ------------------------ ) Septic Tank (Specify Requirements) -------- ----------------------------------------- ------------------ t --------------------r `-Qe- 70414-0- - -- - I 33 �_z Disposal Field (Specify Requirements) --------'--------------------- - --` ' ---- ---------- o <?a4— �]� ----------------- - -------------------------------------------------------------------------------------------------------- --------------------- -- ------ ---------------------------------------------------------------------------------- (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 ubject to Workman's Compensation laws of California." Signed '- -----------�1/----------------------------------------------- Owner // ----------- Title --- ------------------- --------------------------------------- -------- (if other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _��G(------- ✓--� ' �' ------- ----------------------=- DATE �I 1 ------- BUILDING PERMIT ISSUED --------------------------- -------------------------------------------------------------- ------'-------DATE --------- --------------------------------- - - ADDITIONALCOMMENTS - -----------------------•-------------------- ---------------------------- ---- -- ---------------- * - � - � -------------- `�4-4 � - __ _ - - _ Final Inspection by: --- r ------------------- ------------------------------------------ -------------Date -----�/7_4r_-1P-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H`9 1-'68 Rev. 5M