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—z FOR OFFICE USE: 7-/7-(-,F— Cr APPLICATION FOR SANITATION PERMIT{C : _'_ (Complete In Yripliiate} Permit No ------------------------------------------------------i___ This Permit Expires 1 Year From bate Issued Date Issued 7-:__/1' 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: JOB ADDRi_SSAOCATION .__!__ ''�f---_- :- a1-.- ---- --A --•------------- CENSUS TRACT -��---- .-..--------- Owner's -----Owner's Name .A4'4' - -1 04 -----= ----------------Phone ---- Address ------ - "�---- '------------- --------------------------------------------------------- City _ ----- = { �'✓� License #/��,- _ Phone. Contractor's Name ___ _ Installation will serve: Residence ❑Apartment House[] Commercial JoTrailer Co rt i❑ . , Motel E] Other ----------------------- Number ------------- ---/Number of living units:_" Number of bedrooms _---____Garbage Grinder ---— Lot Size __________________ f Water Supply: Public System and name --------------------------•------•--------------------------------------------- ---------------Private, Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.0 { iI Hardpan ❑ Adobe-❑ 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 sewer is available within 200 feet,} PACKAGE TREATMENT SEPTIC TANK S!z [ - _'--------------------- Liquid Depth - ` -------- C Capa,city _"Cap-------- Type ' - Material .1e*V1No. Compartments ___Ir________ Distance to nearest: Well ___._..__Foundation -ZO_`_______-_ Prop. Line _1, --_____ LEACHING EINE No. of Lines g f each line___ __ ---- ------ Total Length------------- Length o 'D' Box ��_s Type Filter Material _Depth Filter Material - Distance to nearest: Well _ Foundation _-_ _ _______ Property Line SEEPAGE PIT [ ] Depth -------------------- Diameter -----:---------- Numberk---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ----------=------------------------ ------------Rock Size --------------------------------- Distance. ----- t Distance.to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .------------ ........ b REPAIR/ADDITION{Prev. Sanitation Permit# ---------------"---------------------------- Date ---------------------------------_) Septic Tank (Specify Requirements) -------- -- ----------------------------------------------------------------•- --------------------------- Disposal -------------------------Disposal Field {Specify Requirements) ------------------------- ----- ----------------------- `-------------------------------------------------------------•------------ , -------------- -------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 4 ! 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." f Signed ----- ------------------•------------------- Owner By --------------- --- --- '� Title ti. /? '�- --- - ---------------- lI o er than owner) , i ENT USE ONLY APPLICATION ACCEPTED BY'------------- ----- - --- DATE ------ BUILDING PERMIT ISSUED ....I------------ --- -- --- --------- --------- ----------------- --------------------------------DATE ADDITIONA COMMEN - - - ---- ----- - --- --------------- ----------------- - ------- ---- ----- --- --- --- - - -----------'v' 3 ------ s �- -- � ��' i' �i- --------�'A /1 -- Finalnsa son by- -----=------- -- ------ - ------- - ------------------------------- ----------------------.Date ,^l ' /n JO WIN LOCAL HEALTH DISTRICT s� E. H. 9 i-'68 Rev. 5