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IT s FOR OFFICE USE: _ APPLICATION` FOR. SANITATION PERMIT i' - ------------------------------------ ---- Permit No:��----------------- (Complete in Triplicate) ---------------------------------------- I 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 'f described. This application made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB � } ADDR] I LOCATION -- --------------- 4 —CENSUS TRACT 5 ~ Own is Name ----- - ----- --------- I N l Address _ / ------ —-------- ------------------------- - City Contractor's. N11me 3 /42------P* -------_Y_5�� -- Cr_..--License # f S11__-__ Phone me J Instdllation:will serve: Residence)WApartment House❑ a- mercia] :❑Trailer Court ❑ A Motel E] Other ------------------------------ ------- N!berNumber of liv'ing units:_-- Number of bedrooms _-2-----Garbage GrindeVi---------- Lot Size ___. ----------------- WaterSupp.ly.�Public System and name --� --------------------------------Private ❑ Supply.: of.-' oil to a depth of 3 fee#: Sand' El Clay ❑ Peat E] Sandy Loam ❑ Clay-Loam .� Hardpan ❑ Adobe'❑ Fill Material ------------ if yes;type ---------------i---':--- -_ (Plotiplan, showing size of lot, location of system in relation to well s,_buildings;.etc.—must be-placed on reverse sides) Q a NEWINSTALLATION: (No eptic tank or seepage pit permitted if pubc sewer is available;within 400 feet,) PACKAGE jTREATMENT [ ] SEPTIC TANK'[ I Size------ -F------ .F _____--13_2Liquid�Dept- h., `'_,___._.-__ �I CaP itY TYPe � �aterial _ __ No:-Compartments Z F ation ----_- Prop. Line ---- 'v ! ; LEACHING L[NE [ ] No. of Lines _________ ____ Length ��ach----_ _------ -----------_ - --_--------Distance to nearest. Well------ Z�_ ---Len--- -- - line---..)'�-�----------- Total Length _.1��..'----------• O.iD' B x _- _-- T e Filter Material _ - --- Doe�Pth` Filter Material _-.�c��---------------------------•-•-•- 0 Distahte to nearest: Well -�_Q �,-- ---- Foundation �----------------------- Property -Line. SEEPAGE.PIT [ ] DeptA -------_--- Diameter ______ Number -___1�_ Rock Filled Yes. No .0 Water Table Depth - �'�`""-� -_Rock Size _= � - � � Distance to nearest: Well __ ---------------__-_-Foundation .__.__.___ top. Line _.__.._.__..__.____.-- i REPAIRfADITION(Prev, Sanitation Permit# --------�----r'a-------------------------- Date -,---------�--------•-•----------} �- ;� tr` Septic Tank (Specify Requirements) `.--------_-_ ` ' Disposal Feld (Specify Retgvirements} -------------i----------------- ___----------------- ------------- I I 1 ff --------------------------- ------------------------------------------------------ ---- - � ,.�(Dxaw_existingiand required addition-on-reverse side) 1. If 1 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-5an Joaquin Local health District. Home owner or licen- sed agents sig ature certifies the following: M "I ca1tify thatlin the performance of the work for which this permit is;issued, 1' shall not employ any person in such manner S{ as to,become subject to Workman's Compensation laws of California." 21 >I f m Signed ------- ----------- - -------------------------------------------------------------------- Owner c-cr 3: B�y. Title - it-� - , - 2 (ilf other than owner) JJ I: FOR DEPA*TMENT USE ONLY i �_ rk _ APPLICATION ACCEPTED BY -,/.• ------ -- --- --- -=-------------------------------------------------------------- DATE --�- ��-�� - ---------- It, BUILDING OERM1T ISSUED ---- DATE DDITIONAL COMMENTS --- ---------------------------------------------------------- --------------------------- t --------------------- --------------------------- ------------------------•------------------------ :Final Inspection by: - `": '`w• -------------------------------•--------------------------------------'Date .:1- � . SAN JOAQUIN LOCAL HEALTH DISTRICT E.LH.19 1-'68 Rev. 5M = l,�