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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - Permit No. !_�-- ---------- + ---- -- ---------------------------------------------- ----------- (Complete in Triplicate -------- ------------------------------------ p // 7C� Date Issued ------------- --------------------------------- - ---------- - - ------ This Permit Expires I 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION -lSS1�. - ':OP -------- -------------- -CENSUS TRACT -------------------------- + Owner's Name - - /, �f a�` '�"�� Phone City ® --- Address - .r��-- `, Contractor's Name License # Z—?ef`_�l'� Phone ------ ----------------------- Installation will serve: Resid ce ❑ Apartment House°E] Cbm�mercial _]Trailer Court 0 Motel ❑Other ---- Number of living units:...... Number of bedrooms -c>?------Garbage Grinder ----------- Lot Size _- --------------- -------- -------- ivate + Water Supply: Public System and name -------------------------------------------------------- Character of soil to a depth of 3 feet: Sand'❑ ilt❑ Clay ❑ Peat❑ Sandy LoaMI Clay Loam.0 ` Hardpan Adobe ❑ Fill'Matericil------------- 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 ifblit sewer is available within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TANK f Size-r_ 11-- J/-�--- "K:47--------- K ~--------- Liquid Depth ---- ----------- e Capacity --- --------est: Type Materi ~ ---- --- No. Compartments _., -----�___-• Distance to nearell - -_-__--5 -----------------Foundation ---__- __ -_- Prop. Line ---------`r.:-------- C e LEACHING LINE t No. of Limes ----------f------------ Length of each line-------- -�}f) Total Length _-- -�?------------------- j� ------Depth Filter Material ---/-----------------•------•--.--••--•-• D' Box -----------_- Type Filter Mate/al ___-� _ _-- r S., � Distance to nearest: Well -._�6----------- -- Foundation ____10------------- Property Line. -__--...-.- -...-_-:.--- ' '°V Rock Filled Yes - No SEEPAGE PIT [ ] Depth __- ------ Diameter - ------- Number - -- ------------- -- �E r s Water Table Depth - ------Rock Size X i Distance to nearest: Well ----------L-119 -------------------Foundation -------1-0----__. Prop. Line -..5.__.----------- REPAIR/ADDITION(Prev. Sanitation Permit# ------- ------------------------------------ Date ---------------------------------- I 1 - ---------------------- ---------------=--------------- � Septic Tank (Specify Requirements ---- ----- ------- ------------ --------------------------------- - I f i Disposal Field (Specify Requirements) ----------- --------------------------------------------- IL ----_-_- -_____-_ '--_--------------------------------------------------------------------------- ------------------ ------------------- --------------- �, (Draw existing and required addition on reverse side) I hereby certify that I have prepared this applicatlon and that the work will be done in accordance with San Joaquin F County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- •. sed agents signature certifies the following: ... "I certify chat 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 --- --------------- Owner ___ _ -- -------------- By ---------- Title - - ---- ----- -- --� - (If other than owner) FOR .DEPA1tTMENT USE ONLY APPLICATION ACCEPTED BY .. - DATE - -- ----- = = # BUILDING PERMIT ISSUED ------ --- - ..mss �-------- --------- DATE ADDITIONAL COMMENTS -------- i------------ --------------- ------------------------------------------------------------------------------------------------------------------------------------ F ---- --- ----- --------------------- ---------- ----------------- l _ ' ------------ ate " Final Inspection by I v SAN JOAQUIN LOCAL HEALTH DISTRICT r 1 ' E. H. 9 1-'68 Rev. 5M