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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No: _.��-- (Complete in Triplicate) ---------------------- ---------------------------------- 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/LOCATIO 7------��` -�------ �-h�_ - U5 TRACT ---___.o�----------____-- Owner's Name --------2r�- _ --- ----------------------=--=�»"- --- ---= --------------------Phone -------------------------- ------ - �j M F------------------- Contractor's Address - - (.� '� �- ------------------------------------ City .- I LS-� -------------------- -----�------- Contractor's Name __.�� ±-°� � � ° /-------------------------------- License # � .r2 ��- Phone --- ----------- Installation will serve: Residence;KApartment House,❑ Commercial ❑Trailer Court 1❑ Motel ❑ Other -------------------------------------------- Number -- -----------------------------Number of living units:---/:_----- Number of bedrooms --A4 ---Garbage Grinder Lot Size 0�� __ _. � ____--__-__ t Water Supply: Public System and.name ------------------------------------------------------------------------------------------------------------o Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam W Clay Lo 01 Hardpan ❑ Adobe ❑ ,Filf Material _----------- If yes, type ---------- ------- (Plot (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,) PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size_____________________------------------------------------------------ Liquid Depth --_.__-_.____-_.--_----_- Capacity ---------- -------- Type -----------------.-- Material---------------------- No: Compartments Distance to. nearest: Well ____________________________________Foundation -___ -------------- Prop. Line ---------------------- LEACHING-LINE { ] No. of Lines _.z__.---___-____-__-_ Length of each line----------------_f_- -__- Total Length ---------------- ----------- • 'D' Box ------------ Type-Filter Material --------------------Depth Filter Material --------------------•--------------_-.----_- Distance to nearest: Well ------------------------ Foundation -- ----- -----------=-- Property Line _.________-:"------...__ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number -------- ------------------- Rock Filled Yes ❑ No Water Table Depth -------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ---------- - Prop. Line ---------------------- k REPAIR/ADDITION(Prev. Sanitation Permit# ________ -------------------- -------------- Date _______-____-_--_______________`._) Septic Tank (Specify Requirements) --- ;( -------- ------- ------------------- Disposal Field (Specify Requirements) --_� ----------- ll--------- ,f Gf1------ ------------- ---------- A�� ' '"i r --------t-�- - --- -- -------------------- (Draw existing and required addition on reverse side) s I hereby certify that I have prepared this application and that the work will be done in accordance with Son 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 .... --------------------------------------------- Owner By ------ than owner) 1' L ---- Title ( ............ a---------------- (I other E FOR DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY --- ----:-- __ -&--Zt----------- -------------- DATE ----7.._l "--_-_--=-------------- ------------------------------------------ -- BUILDING PERMIT ISSUED ---------- ---------DATE -------- � -L::7COMMENTS _7_-?O ---µ- te -------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- --- - ----- - -- --- ---- --------------------------------------------------------------------------------------------- ------ Final Inspection by: _ ____a-- _-__ -F- --- ----- --- -- --------------------------------------------------------Date - �-��-------- -- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT x E. H. 9 1-'68 Rev. 5M"