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FOR OFFICE USE: ] APPILICATIdh FOR SANITATION PERMIT / �o n AP, _�3 Permit No: -. 3-------_.___ - - --- � (Complete in Triplicate) 3 : 3U ------------------------------- This Permit Expires 1 Year From Date Issued Date Issued - --a:__ � 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 -------I CENSUS TRACT Owner's Name ------- Q. ----------- df---------------------------------------- -- ------------=- -------------------Phone ------------------------------------ 1 ---. Cit 490-44-ell, --- ---- - � � - ----------------------- ----------- ------------------•-- Y �' :Zvll Contractor's Name ------------ ]7J----- ---------------------------License #��® _ PhaneJ-� .---•- Installation will serve: Residence Apartment House ❑ Commercial ❑Trailer Court ❑ Motel ❑Other ------------------------------•------------- Number of"living units:____!____ Number of bedrooms ---- ---_-__Garbage Grinder -_ Lot Size 4_'9� f_--------------- I Water Supply: Public System and name --------------------------------•----------------------------------------------------------••------------------PrivateN Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam] Clay Loam:❑ Hardpan (] Adobe,[-] Fill Material ------------ If yes, type ---------------------------- (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer isavailablewithin 200 feet,] PACKAGE TREATMENT I ] SEPTIC TANK Size__ _ - --------------------- Liquid Depth _ :-(-_--.-------- Capacity _��aO - Type, Material_ 11��-r-- No. Compartments -�............... i .} f Distance to nearest. Well -_---�Q----a°-_--_-_---Foundation --� __-----_---_ Prop. Line --_-f :-....._ LEACHING LINE No. of Lines ----- -------------- ength of each line----PW.----__-------- Total Length , ............ - dr 'D' Box A41f-- Type Filter;,ffiateriai FFr a_,Depth Filter Material � --_- --_--_--_----___ .-------_._ l --------------------------------------- I ` Distance to nearest: Well -___F-- --------_ o ion .- --------___- Property Line -60.--.--.-_ SEEPAGE PIT [ ] {Depth ------ -------------- Diameter ---------------- Number - ------------------------- Rock Filled Yes ❑ No i❑ s WaterTable Depth ------------------------------------------------Rock Size --------------------------•----- ,� _,,Distance to-nearest. Well ----------------------------------------Foundation --------------------- Prop. Line ------_------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic Tank-(Specify Requirements)1- ;'---_------------------------------------------------------------------------••---------------------------,_ y-- x -•, ' Disposal Field (Specify Requirements) - = �' -•'----------••------------------------------------------------------ ----------------------------------- Y --------------------------------------------------- ------------------------------------------------------.------------ - -------- ----- -------------------------------------- ------ --------------------------------------------------- T (Draw existing-and required-addition-.on reverse side) I hereby certify that I have preparedithis application and thbt the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and:Regulatipns oflhe San Jo aquin 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•permi44s-•issued, I shall not employ any person in such manner as to become subjeci,to Workman's Compensation laws of California." Signed --------- ;y A' Owner -- -------------------------------------------- BY ------------------- 04) ---------------------- ------ Title - ot rer than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- f DATE __ ��- --- - ----------------- BUILDING PERMIT- ISSUED -------------------d_61----- -DATE ---------------------------------- -- 11 ADDITIONAL`COMMENTS ---- ------------------------------------ -------------------------------------------------- ---------------------------•------------------ ------------------- I'k., q ---------------------- -- -- ------- - ------ - ------------------------- ----------- ------- ------------------------------------------------------------ ---- ---- ----------------------- q Final Inspection by --'=--------------------------------------------- pat - ,/ �„ SAN JOAQUIN LOCAL HEALTH DISTRICT E-H. 9 1-'68 Rev. 5M