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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT �� ------------------------------ ----- -------- -Permit No. --- 0 (Complete in Triplicate) J, Aft ..----------------------------------- Date Issued�_�5-_`�::. _------------------ ------------------_-__--__-----._ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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/LOCA]TION3J�..I�_✓�-3.--5 1kPkp Vlo*j"----CENSUS TRACT ------- ------------- Owner's Name /F-L�_ . .i� •L� IM---------- Phone-.!rW:7-4160-f------ Address ------- fl�'--_ 1> ------._.. City l y Contractor's Name` __...J_ P,CI._C----7-7f,q ---_--------License #�� '�` �. Phon "" .a� Installation will serve: Residence P!?<ppartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ------------------------------=------------ Number of living units-.--/------ Number of bedrooms 3-----..Garbage Grinder oo_9�0_ Lot Size ____________________.___ Water Supply; Public System and name _________ _ ___ _______ ______________-_._____________________.Private [ / Character of soil to a depth of 3 feet: Sand'��Silt _ Y pp Y� Y , ,._.,. - - ❑- Clay- ❑ - Peat❑ `Sandy'Loam=0 -,Clay Loam[]_W Hardpan ❑ Adobe'0 Fill Material -NO--- 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 puublic sewer is av ilable ,) within 2Od feet PACKAGE TREATMENT :[ J SEPTIC TANKSize_Q/!_�___ __..___-___. Liquid Depth T� '[ ________________ ��► " Capdcityf__.2P Type444CW aterial_________ ____ No. Compartments �_...... N Distance to nearest: Well _.10__ ______________________Foundation ---Aq------------ Prop: Line _nt��Ip-------- LEACHING LINE [ No. of Lines ". _______________ Length of each line---- - ---.-- Total Length J.��o---------_---- ------------- Y 'D' Box _L/____ Type Filter Material ACA:--__..-_Depth Filter Material __/9_----------------- --------I...... Distance to nearest: Well _--_--.__._+,`�---- Foundation _.____ Q _.______� __ Property Line ---------- �_._....__ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i1] Water Table Depth ---------------- -----------------------------..Rock Size .--------------------=---------- ' Distance to nearest: Well _______________________________________Foundation -------------------- Prop. Line -------------- ....... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______________.______________---_) Septic Tank (Specify Requirements) ------------------- -'' -------------------- ------- --------------------------- ---------------------- -------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side► } I hereby certify that I have prepared this application and that the work will be done infaccordance 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----56 - Owner -- - Title ------------- ---- -------------------------------------- (If other than owned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- I._R_t0--------------------------------------------------- -----, DATE .. �.- BUILDINGPERMIT ISSUED ---------- ------------- --------------------------------------------------------------------------------DATE ------------------------------------------- '} ADDITIONAL COMMENTS - --------- -- ----------------------- ------------------ ------------------------------------------------------------------------------------------- -------------------------------------- -- --- - ------------------ --- ---- --- - -------- ----------- ---------------------------------------------- <----------- ---------- ------------------------------------ ----------------- - ------ ----- - --------------- ---------------------------------------------------------- -------------- ----------------------- i Final Ins --- ------ - - - ----------------- - Date __-- " r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M