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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------- "' QCompleteiin-Triplicate) +R Permit No. -------------------- r -___.____ 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: I -7Z t7 JOB ADDRESS/LOCATION .-L--o't-------a -"-------------- J> �-► --------------------- CENSUS TRACT .- Owner's Name -- -- --��`=`-�---�-�=��-�---------------------- -------------- - --•-------------------Phone -------------r- ------------- - - Address ----------------- ! `'CIf city - q = ' -------- Contractor's Name _. Q ----- - --- � ---�-- --- - ------ ---------------------------------License #dtk�' RX7-- Phone Installation will serve:.. r. . Residence_J�fApartment House❑ Com mercial..❑Trailer Court i❑ ' Motel ❑ Other -------'_______________ Number of living units:_.__).----_- Number of bedrooms __'3__-_-_Garbage Grinder _-----______ Lot Size ------ ,. --- z ----•-------- Water Supply: Public System and name _____________________ __Private 1�r Ni Character of soil to a depth of 3 feet. Sand Sift El Clay ❑ Peat EJ Sandy Loam -❑ : Clay Loam ❑ Hardpan i p ❑ ,. Adobe ❑ Fill Material ------------ If Yes, type ------- --------------- {Plot pian, showing size of lot, location of system in relation to wel[s, 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'[ ] Size-- - -- � --- Liquid Depth ------ - ------ --- ----- Capacity --tom d------ T e :.f Yp � _ Material-_607.& - ` No. Compartments ------:h._........... Distance to nearest: Well --------- �"Fa--=---------------Foundation -`'--:/-_c* :-:----- Prop. Line ------ J�.----- LEACHING LINE .Li'nes"[ ] No. of, R-_____ ---_----- Length of each line----____- -- --------- Total Length --- _/-- - ----•.---- tD' Sox . _ Type Filter Material ....... ter filter Material __-_,__1_-y_____ Distance to nearest: Well -------- ._0-_Q----- Foundation ------ ' Property Line f`�-•-, ....... SEEPAGE PIT { ] Depth __ _ _L'"'_____ Diameter 44-W-42 Number ___--.__ -______________xRock�Filled Yes No �❑ Water Table Depth ------------------------------------------------Rock Size ------ ------- Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line ------------- ...... • REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- --. -- Date -----------------------------____-) Septic Tank {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 �t as to become subject to Workman's Compensation laws of California." Signed ------------------------- ---- --- -------------------------------------------- ---------- Owner BY --& ---- - - --------- Title --------------- --------------------------------------- ot ler than nerl R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.___-_.__ - ------------- - -------------- ------------ - - - DATE -- - �----l-�•'��------- BUILDING PERMIT ISSUED ------- ___._____.____ ----------------------------------------------- ---------------------------------DATE ---------- ----------:-�_---'----------- ADDITIONAL COMMENTS .____-_______ ----------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------=:----------------------- --------------------------------------------- Final Inspection by: ----------- -- ------------------Date -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M