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f s� f FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �i ---- ��.--=�/-- ------��=. °�-�---- � Permit No: �O-_'_��.� �f (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 described. This application is made in compliance with County Ordinance(Na: 549 and'existi'ng R0.es and Regulations: JOB ADDRESS/LOCATION ._--- .--- ---y ?--- CENSUS TRACT -------------- ----------- JOB Owner's Name ._ ---- ----�--- Phone ,7- Address ��-- CitY ------------------------------------•--- ------ --- -------------- Contractor's Name _ - ----_--_ -----.License # �_K --- Phone _ �--------�---- Installation will serve: Residence�Apartment House'❑ Commercial ❑Trailer Court ❑ Motel ❑Other --------�------------------------------=----- r *k Number of living units:______ Number of bed ooms __St7 ___Garbage Grinder ----- ------ Lot Size ------ ------- Water Supply: Public System and name --------- Private ❑ # Peat Sand Loam Clay,Loam • Character of soil to a depth of 3 feet: Sand❑ Silt❑ clay ❑ ❑ Y ❑ Y ❑ 'f _ Hardpan E] Adobe Fill Material ____________ If yes,type ---------------------------- ] /(Plot plan, showing size of lot,notation of system in relation to wells, buildings, etc. must be placed on reverse side.) t -,NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 'PACKAGE TREATMENT ( J3 SEPTIC TANK:[4]'t" Size----------------------------------------------- Liquid Depth --------------------,-•- Ca aci T c e' }�- Material No. Compartments -----------_---= P tY ------------------ YP ' ---------------Foundation _.-------------------- Prop. Line -------- ------------ �"'"""� Distance to nearest: Well _____________________ �► LEACHING LINE [ ] No' of Lines ------------------------ Length of each line--------------------- ------ Total Length ----------------- ------ ( 'D' Box ------ Type Filter Material --------------------Depth Filter Material ---------------------------------------- Distance to nearest: Well ------------------------ Foundation ----------------------t-;Property Line. -------------------- --- SEEPAGE PIT [ ] Depth -------------------- Diameter ------------- --------------'Rack Filled Yes No � t Number ____.______- 4 Water Table Depth ------------------------------------------------Rock Size -------------------------••----- Distance to nearest: Well ----------------------- -----Foundation --------------------. Prop. Line ----------•---•------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------- -°-- Date ----------------------------------I �. .: - - Septic Tank (Specify Requirements) --------------------- ---- ------- ----------------------- ------ Disposal Field (Specify Requirements) _ - ---------- --------- --- ---------- - ------- ------- -------- r -------------------------------- Z-6-- -- --- --------- - -- - -------- - ------- -------- ------------ --------- --------------------- ---- --- -------- ------------------- - - 1 (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 beco su ject to.W man" ompensation 1 of California." Signed __ Owner - - - - -- -- ---- - - - - - -- - --- - ----------------- Title ---- ---------------- -- ----- ------------ ---------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --4_____- t DATE ------�- --?' --- `5� BUILDING PERMIT ISSUED :------•-------- DATE . ----------- ADDITIONALCOMMENTS --------------------------------------------------------- --------------------------------------------------------------------------------------------- - -------------------------------------------------- - -- - ------ ----- - - ----------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- -----------------------------------------------------------�-1--�- Date Final Inspection b --------------�h1 W. --s-- --- ---------- ---------- ----------- -- -------- i SAN JOAQUIN LOCAL HEALTH DISTRICT . i E. H. 9 1-'68 Rev. 5M