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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------ - -------•---------------- - Permit No. _." _z (Complete in Triplicate) ---------------------------------------------- -------------_----_-------.-------------_-----_-_----- < This Permit Expires 1 Year From Date Issued Date lssued/,�:�"4?4-.. 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION _04,5 ------06 ----------- /E__ 4/------------1-4----------CENSUS TRACT -------------------------- Owners Name - C�. ----------C`> .------------------ - �-------Phone ------------------ -------------- ' -- Address ----�,-,'V 1 ---------------------------=------------------------------------------------- City ------------------------------- --- ---------------------------------------- Contractor's Name Lp-------------------------------------------------------------------License # ---------:-------------- Phone ---------------------------- Installation will serve: Residence %Apartment House[] Commercial ❑Trailer Court ❑ Motel ❑Other ------------------------------•------------ Number of living units:----/---. Number of bedrooms _1----Garbage Grinder ------ Lot Size XaZIV------------------ ' Water Supply: Public System and name --------------- ---------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat[ Sandy Loam ❑ Clay Loam[] 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 I ] SEPTIC TANK ------------- ---- Liquid Depth - �L---_---_..___ Capacity _101iVyst I)fype _ -------------- Material_ dot!' Vo. Compartments --- --`------. Distance to near Well -..1�l�-----------___--_----.Foundation _-. ---____--prop. Line -- ------------ Distance LINE No. of Lines ------ ------------- Length of each line------ D--_-___._____ Total Length ------____ ` i� 'D' Box --- _-_ Type Filter Materia! _1_RCJG/</Depth Filter Material --_ ---------------- Distance to nearest: Well _13�---_------- Foundation _��---_____--- Property Line --_ Q............. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -------- ------------------- Rock Filled Yes [] No .i❑ WaterTable Depth ------------------------------ -----------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----------__---__-. REPAIR/ADDITION[Prev. Sanitation Permit# -------------------------------------------- Date -_-------------__.-_---_------..} SepticTank (Specify Requirements) --- ----------------------------------------------------------------------- ----------------------------------,-.--------------------------- T1 DisposalField (Specify Requirements) -------------------•----------------------------------------------------------------------------------------------------------------- n ----------------------- --------- -------------- --------------------------------------------------------------------------------------------------- ----------------------------------------------------- �+ ------------------------------------------------------------------------------------------------------------------------------------------------- ----------- -------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 ublect to Workman'765��mpe satin aws of California." Signed ------ ---- --- ---- ��' -Owner BYTitle --------------- -- -------------------------------------- -------------- (If other than owner) /FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED -�- ----------------------------------------------------------- DATE / BUILDINGPERMIT ISSUED --------------------- ------------------------------------------------------------------------DATE --------- •-------------- -------------- ADDITIONALCOMMENTS ------------------------------------ -------------------------•--- ------------------------------------------------------------------------------------------- -------------------------------- ------- ------------------------------------------------------------------------------------------------------ ------------- ------------------------------- --- ----- - -- Final Inspection ---------------------------------•---------------------------------------Date _4�.-�-9-- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.