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FOR OFFICE USE: APPLI' x►TION FOR SANITATION PERMIT Permit No. Ste_ G_7 - -a -: (Complete in Triplicate) -- -- -- - - Date Issued In l yd -----------------____-----------------.------------------ 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 �cco'mpli��ayyn��ce with Cqunt Ordinance No. 549 and existing Rules and Regulations: AZ V�04- JOB .ADDRESS/LOCATION _ 4014_./-_-----f4•_____ ___ --- --------------------------CENSUS TRACT -------------•---==------ r Owner's Name -q-_ ----------------------------------------------------/!� _ ___------ --Phone ,T� t ..�c.E-�Jf'1� - ----- - - - - --- - ------------------------------cit-- -- ----- Address —_ License--#,,-Y - - _ Contractor's Name _ /.� Phone S_1 _ .,4 Installation will serve: Residence [V Apartment House,❑ Commercial,❑Trailer Court rx Motel ❑ Other -------------------- ----------------------- Number -------- -------Number of living units:_______, Number of bedrooms __ .Garbage Grinder Lot Size i, Water Supply: Public System and name --------------------- ------- ---------- ---------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ ' Hardpan ❑ Adobe E] 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 seweris available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_--- _____-__________ ____ __ _ Liquid Depth ___ ________--__---___ Capacity _-.-- Type -------------------- Material--_----------------- No. Compartments .--__--_--- Distance to nearest: Well ___ -____ _--___ __________ ___-_Foundation --- ------------------ Prop. Line -----------_---------- LEACHING - ____-_LEACHING LINE [ ] No. of Lines ------------------------ Length of each line--------------------------- Total Length ..... .. ....... ....--___-_y � 'D' Box ------------ Type Filter Material --------------------Depth Filter Material _____-___ I ; Distance to nearest: Well______________________ Foundation _______________________ Property Line ..----------------_--- i SEEPAGE PIT [ ] Depth --___- Diameter ________________ Number __________._--_-_._-____.__ Rock Filled Yes '❑ -Nor 0' E Water Table Depth .-__--_--- ______--Rock Size _______________________________ t Distance to nearest: Well -_-------------------------------------Foundation .-------------------- Prop. Line ...................... k REPAIR/ADDITION(Prev. Sanitation Permit_— -------------------------------------------- Date ___--: _ :.__.______._._____) Septic Tank (Specify Requirements) - - - ---- - s -- _,,,_ e Disposal Field (Specify Requirements) Q _ _________ __ __ ____ ' ---------------'--------------_--------------------------------------------------------------------------------------------- (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 k as to become sub' ct to Workman's Compensation laws of California." Signed .. ---------- Owner - -- -- ----- t By r_ --------------- ------ -- Title ---------------------- ----------------------------------------- z< (If other than own f �t FOR DEPARTMENT USE ONLY M. APPLICATION ACCEPTED BY ____ _ ------------------ _ ---------------- ----- ------- ---------. DATE - BUILDING ATE BUILDING PERMIT ISSUED - - - -----DATE ------------- ----------------------------- �' ' j ADDITIONAL COMMENTS -------- - ------ - - ----- --- ------ --- -- ---------------------------- ;:,.g�. - - ---------------------------------------- `' ------------- ------------------- Final Inspection b � _ �-� --------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT , E. H. 9 1-'68 Rev. 5M