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I �- FOR OFFICE USE: ! APPLICATION FOR SANITATION PERMIT ! . ` �. Permit No: F (Complete in Triplicate) ---------=-- ------ ----------------------------- ------- -------------------------------- This Permit Expires 1 Year Froin Date Issued Date Issued Application is hereby made to the San Joaquin Locdl Health District for a permit to construct and install the work herein w 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 �_M� -� one ---------------------------- Address -.-- '{ ��- ` City ` Contractor's Name -------E.--- .License sz f # --/e tf 2 yPhone ------------------------------ Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court !❑ Motel ❑Other ._-/1L__J- _----------�'r Number of living units:---.'----- Number of bedrooms ___ -___Garbage Grinder ------- --- Lot Size __-----— Water Supply: Public System and name ---------------------------------•-------------------------------------- --------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam © Clay Loam :❑ Hardpan ❑ Adobe [r 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 [� Size__ _-__�__`---- _._If 5---------------------------------- Liquid Depth -'/-_-______---.-------- C Capacity _.�_?0 '___ Type __ __ _ _ --- Matenal_e — No. Compartments _y______________ } 1 r r Distance to nearest: Well ___________ 0e)__________________Foundation __.__ --- -------- Prop. Line ___•S-__:__:____. - N) 1 ' 3 a LEACHING LINE [e No. of Lines -------r_____-_________ Length of each line _(3 Total Length --------------- 'D' Box)(L-4------ Type Filter Material __--$1Z,--------Depth Filter Material ____If___ ------------_______________ Distance to nearest: Well ------------------------ Foundation -------- --------------- Property Line. _______________-..----- 1 L f, SEEPAGE PIT [ ] Depth ____________________ Diameter ____-____._____ Number _.._.____.__-____.___---.___`Rock .Filled Yes ❑ No I❑ WaterTable Depth ------------------------------------------------Rock Size'-------------------------------- Distance toInearest: Well ----------------------------------------Foundation -------------------- .Prop.-Line --------------- ...... Permit# -------- --- ------------------------------- Date -------------------- --) ` REPAIR/ADDITION(Prev. Sanitation;! ---� -- - Septic Tank (Specify Requiremen#s) ------------------- "` ---------------------------------------- Disposal Field"]Specify Requirements) ____________ - ------------------------------------------------------------------------------------------------ -------------------------- ---------------------------------------------------------------- - I ------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------- I(Draw existing and required addition on reverse side) 1 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 subject to Workman's Compensation laws of California." Signed --- I - ------ -------------- Owner �� ------ Title --------------------- ----------------- (if other than owner)i I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------- DATE ----41-1------f--/ ---------------- BUILDINGPERMIT ISSUED -----------i ----- -------------------------------------------------------------------------------- -----DATE ------------------------------------------ ADDITIONALCOMMENTS ------------ ---------------------------------------------------------- -- ------------------------------------------------------=--------------------------- 0 ---------------------------------------------------------------------------------------------------- --------------------------------------- - --------- -------------- -----------------------------------------------------_---------------------------------------------------------------------------- ------------------------ ----------------------------- ----------------------------- ------------- --�1 _ Final Inspection by: Dot e7.."_ y~ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M .;