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T� FOR OFFICE USE: 1. 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: ry�� JOB ADDRESS/LOCATION ._/S �.1� /r / CENSUS TRACT 591 Vt Owner's NamePhone ----- I Address ------ City E Contractor's Name '-�' License # - JV39 Phone ------------------------------ rInstallation will serve: *idence Apartment House�❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ----------------------------------------- I Number of living units:------/... Number of bedrooms _______Garbage Grinder -__- ------- Lot Size _4__ - - -t� —__________- Water Supply: Public System and name ------------------------------------- ----------- ---- ---------------------------------------------------------Private ®ll-1, Character of soil to a depth of 3 feet: Sand❑ Sift❑ Gay ❑ Peat❑ Sandy Loam •Clay Loam ❑ -x Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- - G (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----k .------ ----------- -+.--------- Liquid Depth -------------------------- Capacity ---------- ---- ---- Type-Io--- r-- ------ Material---------------------- No. Compartments --------------........ W Distance to nearest: Well ------------------------------------Foundation ------------------- Prop. Line _--------------_------ ;E LEACHING LINE [ ] No. of Lines_________________________ Length 'of each line----------------- ---------- Total Length ----------------------- 'D' _____-___'D' Box ------------ Type Filter Material ----------------Depth Filter Material -------------------- Distance to nearest.-Aeli ------------------------ Foundation ----------- ------- -- Property Line ______________-__.:..__ SEEPAGE PIT [ Depth - ------------------ Diameter ----------------- Number ---------------------------- Rock Filled Yes ❑ NoO I Water Table Depth -------------------------------------------------Rock Size -------------------------------- ----------Foundation -------------- ---- . -----------------• -- PropLine t. Distance to nearest: Wel! ______________________________ _ REPAIR/ADDITION(Prev, Sanitation Permit# ------------------------- _________________ Hate ------------------------------------ Septic _--______- --_---_____________-_-Septic Tank (Specify Requirements) ----------------------------------- ---------------------------------------------------------------------------•=---------------------------- Disposd! Field (Specify Require ments) ------I? w .�xJ -------.-'gip--- --- `- ------------------------- ---- -------------------------------------------------------------------------- �, i (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 subject to Workman's Compensation laws of California." Signed ----------- --------- - 1 Owner - ---------------------------------------- - itfe BY ----------------- ------------------------ (If other than owner)i 4- FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - --- ----- -- - ------------------------------------------------------------- ------ DATE BUILDINGPERMIT ISSUED ------- --------------------------------- -----------------------------------------------=- -------DATE - ---------------------- ADDITIONAL COMMENTS - ------------------------------ -- ------- ---------------------------------------------- ------------------------------ ----------------------------------------------------------------- --------- --- ----------------- --------- -9---------- Final Inspection by: -------- - - ----------------------- -------Date _'-ll- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M