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FOR OFFICE USE: / /,_ 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 compl'ran with County Ordinance No. 549 and existing Rules and Regulations.. JOB ADDRESS/LOCATION .----.-�?�v- 'fi - ------ f - -` ------- ------------------------CENSUS�TRACT ------------,o------------- Owner's - -_-_------ Owner's Name ---------------, ----- - � -j-- --- - ------_---------------------- Phone _11K.3---- ®3 Address --------- 2L A_ /d a cam"`ti Cit f Y Contractor's Name -- -------=--------License # --------------------- --- Phone`./a/_--_ !�q.:7.- Installation will serve: Residence ❑ Apartment House,❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number ------------------------------------- ----Number of living units: ;"-� Number ofrbedrooms__3;_-'-'Garbage Grinder Water Supply: Public System`rand name -------------------- ti `�.---- ----------- -- - --------------- ------ ------------------------ Private Character of soil to a depth of 3 feet:w.Sand❑ ,_Silt❑—Clay .,❑ Peat❑—Sand.y_Loam ❑. Clay Loam a] Hardppn ❑ Adobe Fill Mate6611 If yes, type -.".--------i--------------- (Plot plan, showing size of lot, location of -system= in relation,-to-wells, buildings, etc. must,be placed on reverse side.) NEW INSTALLATION: �4No septic tank or seepage pit permitted'i publi wer is available within 200 feet,) PACKAGE TREATMENT' .I ] SEPTIC TANK f I Size------------L__ _=_:____ ____-____.---------------- Liquid Depth _____.___________.________- i ------- No. Com tments ---- Capacity ----------- ------- TYPe Material p . Distance lb-nearest: Well --\--------------------------_-----Foundation ---------------------- Prop. Line --------------:_------- ' �LEACHING`LINE [ ] INo. of Lines ----------------------- Length of each line.--------------------------- Total Length --------------------------_ M -- -�y Type E -- -- _---.Depth Filter Material ___---_- _-- D' Box -------_-_-- T e Filter Material -------------------------- ;Distance to nearest.-Wel ------------------------ Foundation _______________________ !Property. Line _._______________.:____ SEEPAGE PIT [ ] ;Depth --------- --------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No :i❑ t I Water Table Depth ------------------------------------1-----------Rock Size ------------ I j t I , E Distance to nearest: Well ---------------------------- ----------Foundation -------------------- Prop. Line ----------------.----. i REPAIR/ADDITION(Prev.1Sanitation Permit# ________ __________________________ _______ Date ________________________i_______) Septic Tank (Specify Requirements) i-------------------------------------------------------------- - i r J i ---- Disposal Field (Specify Requirements) ---------- ___-- - Q - -*rf--,-- a ---------------------- ------- ` - = _ z ,- ----- - ------------- ----- -- --- : _._ - ----- ------------------ _______ ----- _ ----------- ----------____ ________________.___._ ________________ ____________ �* �-, (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 ---- -------------------- - Owner' ~~----.- .. BY /- /V-`---" r------- Title - �( r - ------------------------- (If other t owner) FOR .DEPARTMENT USE ONLY �� . �S1R B t-�{` Fk- = APPLICATION ACCEPTED BY °--------------------------- "` - -----. DATE -- ^-1-d-7--6-7-------------------- BUILDING PERMIT ISSUED .---------- _..—.... ,� - ._ TE _. ADDITIONAL COMMENTS ------------- ---------------- ----- ------- -- - - --- ----------------------------------------------------------------- ---- _ - � 1 � ----- ------------------------------------------------------y -- - - ---------- ---- - ----------=------- Final Inspection by- --------------------- -------------- ' ' __. Date _. y _� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.