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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT z , ..................................._.------------- Permit No, (Complete in Triplicate) .................... ............................... This Permit Expires I Year From Date issued Date Issued ./Q.: ... 1•P.:?� 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 unty Ordinance No. 519 and existing Rules and.Regulations: qq SUS TRACT .......................... JOB ADDRESSAOCAT16N . ..:._CX.�U .. ._.... . .. .............. . ... .... .. Owner's Name :.-•--•................. - ...................--.. on r 1 Address .-..._. .�'d - _. ... -- :... City ` --- Contractor's Name - - --- --. .Q ..., • •-•. . ..... ........License 06; r Z171J-"-_:._ Pho Installation will serve: Residence)J'Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ------------------ ......................... Number of living units:.__._._ Number of be ooms ........Garbage Grind r Lot Size ... ...................... f _.-Private Water Supply: Public System and name ...... .. . . . ... ... .. ... .....� ____.. ...._.._...-....•------•--....•........... -�Chardai-r of so+l to a depth of 3 feet: Sand In-tilt❑Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material ............ IF yes,typeI (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' Size._ �'�_��.fl................. Liquid Depth _474..._.............. Cap"cit ._.___.__ Material.___.�� No. Compartments ... ........... Distance to nearest: Well ____...._4V.:..............Foundation ..._ Prop. Line ..49...... p r r � LEACHING LINE P< No. of Lines ....... Length of eachlineline.___.__OC -_.___... Total Length __.. � ........_. ; 'D' Box .....L-.._ Type Filter Material _/.�1�__......Depth Filter Material . �.............................. ' d._ .�........� _ Distance to nearest: Well ------- . __.___. Foundation f... _ 0............. Property Line ....._. ._. SEEPAGE PIT [ 7 Depth .................... Diameter ._.._--..._.._.. Number ------------_---------._.. Rock Filled Yes ❑ No ❑ Water Table Depth ... ..........Rock Size Distance to nearest: Well ----------------------------------------Foundation ------------..__-._. Prop. Lifit,,......_.:----.-----..� REPAIR/ADDITION(Prev. Sanitation Permit# .-:................................... .. Date ..................... SepticTank (Specify Requirements) ................... -_------------------- ......................................------------•-•--.........._.._........................... ._-------- - I 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 subject to Workman's Compensation laws of California." Signed ...................... ................... --------------------------------- Owner By ......... - Title ....: (I th an owner FORD ARTMENT SE ONLY APPLICATION ACCEPTED B •. --•- _ svtl r. . ....'J /-----....... DATE ....r ../.�V7j:..... BUILDING PERMIT ISSUED ....................... .. --- ... DATE ADDITIONAL COMMENTS ........... ........................I. --•- ._..... ...... ------• ------•-----_.... ---•----------------- ..................... .............----- •----•-- = --- -- -- . ......................................... ..... Final Inspect+ ......................... ate ...._.. ...':...._------ SAN JOAQUIN •LOCAL HEALTH DISTRICT F_ H 13 24 9.'68 Rev. SM