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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------ ----------------•-------- ------ Permit No. -1--3_`/$' 0 (Complete in Triplicate) This Permit Expires 1 Year From Date Issued ---------------------------------------------------------- Date Issued ___ _'��_��. --------------------------------------------------------I Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATION -- '¢-�� --- .5. .f�ilY ----- ----------------------- --- -CENSUS TRACT�/ Owner's Name -------�/�t 71-1_ s' lllL ---------------------------------- Phone /7�_� ----------------- Address - ---�4-se City l it, ------------------- ----------------- ------ Contractor's Name -----------------License # Phone _ = Installation will serve: Reside nc XApartment House❑ Commercial :❑Trailer Court Motel ❑ Other ------------------------------------------- � r Number of living units: Number of bedroo s _____Garbage Grinder ------------ Lot Size -- x !Q Water Supply: Public System and name ------------- W --------------------------------------------•------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe4 Fill Material ------------ 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 if public s�erg is available within 200 feet,) r/ PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_ f --------------_-_____ Liquid Depth ---- .3� ----------- Capacity -.________Ca acitY -.?,Poo------ Type 6_9577 MaterialCompartments -----�. _______- Distance to nearest. Well ----/J/^^ ,& ----- Foundation ______ Prop. Line .1-.5�- LEACHING LINE [ ] No. of Linesr g r ----�-------_-__-- Length of%ash lie_____-.SSS______________ Total Length 'D' Box 46AJ-_- Type Filter Material -----Depth Filter Material -----/Z__________________J___..____-_ Distance to nearest: Well _/__!_- J------ Foundation _,/_0--`------------ Property Line ____S_______________ SEEPAGE PIT [ ] Depth __. �______ Diameter _4ipA --p-- Number -------_�._________„ Rock Filled Yes No ❑ ` Water Table Depth --------�e-------------------------------Rock Size - 1C_ __ i Distance to nearest: Well ------- &r'J.dle-___________.......Foundation _f ------------ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------------------_--------- Date _______________.__________________) SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- --••---------------------------- Disposal Field {Specify Requirements) --------------- ------------------------------------------------------------------------- ------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------- (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 iect to Workman's C mpensation laws of California." Signed --- ^�,e -- ---- ----------------- Owner BY --- -------- --------------- ---------- Title ------------------------------------------------------------ f If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .-(—'- ---------------------------------- -------------------------- DATE ----'tom' ' ------------------- BUILDING PERMIT ISSUED ------------------------------ ------------------------------------ - - --------DATE --- ---- -------------- ADDITIONALCOMMENTS ----------•----------------------------------------------------------------------------------------------------------------------- --------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- -- ---- --- -- - --------------------------------------------------- ------------------------- --- Final Inspection by - ------------------------------------------------------------------------------- -Date , /.� SAN JOAQUIN LOCAL HEALTH DISTRICT k�-zO E. H. 9 1-'68 Rev. 5M