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' FOR OFFICE USE: ,.{.- APPLICATION FOR SANITATION PERMIT -- ------ -- = �,J I / ?3 (Complete in Triplicate) Permit No. --------- ----- _______ _______________ This Permit Expires 1 Year From Date Issued Date Issued i 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. 549 and existing Rules and Regulations: { r JOB ADDRESS/LOCATION . _ ___,61_7/_________ 7-e 4-----------,- ��--,�-'------------------CENSUS TRACT Owner's Name v' •� -f_. %� i7ls�_�C�a /t_1C ----.Phone 2.�� c Address -.aSv �_. --- ---SP`-QCCit Y--------------------- :S �'l�j`� - fl Contractors Name _IA-.4--,5--.-- r'S ---------------- - ---------------------License # � .3- Phone � � � r Installation will serve: Residence E]Apartment House❑ Commercial 1�Trailer Court ',❑ k Motel ❑ Other -------f----------------------------------- Number of living units:___-- *-___ Number of bedrooms __:---------Garbage Grinder ------ ----- Lot Size _____________________-______--. ._ Water Supply: Public System and name _____--__--I--------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ : Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe q Fill Moterial ------ ----- If yes, type ____________________ de (Plot plan;.,`howing,size-of lot, .ocation-of system in relation to wells, buildings, etc. must be placed on reverse side.) 4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (`p1 r "1 PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] _�` Size_-___- ---------------- PACKAGE ____ _________ �' Liquid Depth ---------------•-----.----- Capacity -------------- Type -------------------- Material -Y>.:�----- No. Compartments ----------------------- to = • Distance `to nearest: Well ------------------------------------Foundation.-k-------------------- prop. Line ---------------_---_-- LEACHING LINE [ ] No.yof_Lines - J------------------ Length of!each lihe---------------- �_ Total Length _--___ _ i i - -------------------- 'D'«Box ------- Filter Material _--#_______________Depth Filter Material -------------------- ' Distance to nearest: Well ________________________ Foundation -------------- I .---______ Property Line. --------- SEEPAGE PIT f ] Depth ----r--------------- Diameter -_-------------- Number --- Rk Filled Ye --------------- ------- Rock Yes ❑ No 0 ; Water�Tab e Depth ----------------Rock Size -------------------------- .� Distance to-nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------_--_-----_ REPAIR/ADDITION(Prev. Sanitation.Permit# -------------------------------------------- Date --------------------:-__ 'Septic Tank (Specify I Requirements[ --------------------------------- DisPosal Field (Specify Requirements) _ ------ Cr 11 ? -•---- ------------------- ------ -- ------------------------------------------ r (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' ani# 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 Com ensation laws of California." Signed ... - Owner By - -------------------------------- -------------- -- Title 4 - - -- - --- - - --- -- [If other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ° - DATE .__S --- -------- ..------------------ BUILDING PERMIT ISSUED -.---------- „ -------------- DATE ------------------ ADDITIONAL COMMENTS -------- P��.�__-_-�� y� - G�r1_�/ ------------- --------- -------------------------- -------------------------------- ------------- --------------------------------------------------- ----- ------ ---------------------------------------------- ----- --------------------------------------------------------------------------------------------------------------------------- -- ----------------------------------------------------------------------------------------------------- Final Inspection by; ----= -- = - - ----------- ----------------- -------- ------- ----- -------------- - ----,Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. I