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s FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� ............... • •---�.........._............ Permit No. .. .....'.... . .._. IComplete in Triplicate) ......... ............................................... i� ) 7 7f .._... 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: JOB ADDRESS/LOCATION ! / . CENSUS TRACT .......................... Owner's Name ... _.. ......._.. ....Phone .. _-- . Q .- . - �JL._....7.&.a.... Address ... .CI yr__....... "``- ..._ 'G '... ..... City ... .. ---- ---- --- ----•--•---------•--•- ........... Contractor's Name ------.__License Phone Installation will serve: Residence 'Apartment House❑ Commercial [-)Trailer Court ;❑ Motel ❑ Other . .. _ Number of living units:..... . Number of edrooms .._. .-_Garbage Grinder . .` lot Size -.,�.Z.407...ooc!t€�.__.__------ ' __......PrivoteX Water Supply: Public System and name . .. ._ ..-- - ----••--- L---•-•---------••--------_..............._...._. Character of soil to a depth of 3 feet: Sand n 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 240 feet,) PACKAGE TREATMENT [ SEPTIC TANK Size. �, 1 ; .. qDepth r Capacity dVt�j-� Type,&4&1�a.._ Material-. "X, No. Compartments Distance to nearest: Well ______________Foundation ...�G... ...,... Prop. Line .._6—__.__r-__-._--_- LEACHING LINE �' No. of Lines Length of each line Total Length _ . .................. f 'D' Box .. .�. Type Fitter Material _. �.___._Depth filter Material .� _______________________------------ Distance to nearest: Well ..__,__..-_ Foundation 6c�_�....-.- Property Line S`................. .v SEEPAGE PIT Depth �... _ Diameters-- ------ Number __ Rock Filled Yes No i[J Water Table Depth -.----•-- C .........----------------------Rock Size ....1�'Tl _`. Distance to nearest: Well ....� _........---.._...._._.._.Foundation .._. . r..... Prop. Line .. . f REPAIR/ADDITiON iPrev. 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 Sari Joaquin local Nealth District. Horne 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 . .... . _.. $� . ._ ��L ._........ Title f/ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. DATE -------------- BUILDING PERMIT ISSUED . DATE . ............................. .._. ADDITIONAL COMMENTS ., . ............ .. .. . . ...... . .. ... .. ............. - ----.-------- ........ ............. . ................... ...... ......I.......... ..... --....------.-- ............... .... . . ............................. ...... FinalInspection by: --------------- -r. _,...... ......... ------------ __--------- --------------- ....--- ......... -------------Date ,..l..4Y SAN' JOAQUIN LOCAL HEALTH DISTRICT ,. E. H. 13 24 1-'68 Rev. 5M - t _. - '7172 3 X