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j FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----------- ------------------ 3 7 11.� (Complete in Triplicate) ,. -- ----------------------------- _' 1' Date issued _-- 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .------- - -- --- 1I3_�-----� ---- - -- -- CENSUS TRACT --------- ---------------- T41 ION Name ----- - `-cl --------• Phone •r,� --�'c.5 ------------ -. Address -, --- -----------------•-- ------- - �` Lice # hone - City 1 ... Contractor's Name -- -/Q4a°�Y nse E Installation will serve: Residence f Apartment House�❑ Commercial ❑Trailer Court ;❑ I Motel ❑ Other ------------------------------------------• J Number of living units:.___---_ Number of bedrooms ----- .Garbage Grinder ___— Lot'Size _.'�_�--�_�'1--L--UQ - ---.-.- 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 Fill Material -------- --- if yes,type ---------------------------- L (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 -------------•-------- �V Distance to—nearest:-.Well--_�-----<--�--- ===--Foundation ----00._ ___ Prop. Line ------------ -------- \ Total Length ----- l -•---- LEACHING LINE p(] No. of Lines ---------�_.___------- Length of each line-------- `D' Box ---1-----_ Type'Fiite� Material _-_---�_,___Depth Filter Material _____.--, _----------------/.•---- �{ Distance to nearest:fWe.11 _.___—rte'------ Foundation ------'1-�------ Property tine. -___�...----------- — /A Ste ] If Depth ____ -�-- --- Diameter ___ /Aumber -__.----.___ ---:---- Rock Filled Yes rM No ❑ � n L r') Water Table Depth -------- ------ ----47-40 --------- ----- ---------•••---- � Distance to nearest: Well------ __'--:-- "'----•-------Fouridation ---- Q-�_ Prop. Line ----- _ ........ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date'_------------------------•-------) Septic Tank (Specify Requirements) ------- .;-------------------------------- - --------------------= Disposal Field (Specify Requirements) ----------___________ -- ---- 4 yy� -------------- rl -------------------------------------- ------------------------- ------------------------- / �Q f ' ----------------------------------------------------------------- --------------------------------- - --------------------------------------------------------------------- ------------------------ --------- - (Draw existing and required addition on reverse side) ,y 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, 1 shall not employ any person in such manner as to become subject..tor Workman's Compensation laws of California.' Signed ---------- ---- - '---------- '- = €----------------- -------- Owner BY --------- ---- - :--r:- --- --- ------ ---------------- Title (If other4cih,owner) F DEPARTMENT USE ONLY ^^�� APPLICATION ACCEPTED BY . -- ------. DATE _.- � st -" 7 z-_ ---- --- --- --------------- BUILDING PERMIT ISSUED ------- ------------------ DATE ADDITIONAL COMMENTS ----------------- --- ----------------------------------------------------------- j ------- ------------------ --4 - - ------- - - -- ----- ------ ------ ------ , ---------------------- C --------------------------------------- ------ 1� _ _ __ -.� - --------- = Final Inspection by: -- - - - ----------------------- ----- ate --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M