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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate] Permit No. _-�� --_-_ --------- - ---------- This permit Expires 1 Year From Date Issued Date Issued __1--------------- 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 -_ $ __ - � 12t ------------- ---- S --- -- - --- ----- CENSUS TRACT - - y�------------- - Owner's Name 01_ - -----------Phone --- - ---------- ---------------------------------------------------------- -------- - - - Address __ .75 Cit �1 r Y ----------------------------•------ Contractor's Name --Caw- P _ irLicense # _1��.3�'--�' Phone ------------------------------ Installation will serve: Residen []Apartment House❑ Commercial-❑Trailer Court I❑ Motel ❑Other -------- -------- Number of of living units:------- Number of bedrooms _2'�7.-Garbage Grinder ----- Lot Size ' -------------- ----------- ------------------------------------------------- Water Supply: Public System and name ----------------"-__-- ---------------------------Private [ Ic - Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cla y [] 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 seep pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT [ ] SEPTIC TANK [ S1Ze_ may{`f �,r l ------- Liquid Depth 4,..-- --•-------- Capacity _. .Qr•_ Type _ Material-__. ! .. No. Compartments Distance to neare t: Well Sc} r - E --------------- ---------4-----Foundation ----/Q ------------ Prop. Line ----'-----•-------•-- LEACHING LINE [�No. of Lines _______-_7----------- Length of each line. --------- ------ Total Length ----/Pd? 'D' Box -----1-___.- Type Filter Material ---___$__X___-_Depth Filter Material -------(t`` --- ------------------------------ Distance to nearest: Well --------6b-_-- 'f--_ Foundation -----1-C-------------- Property Line -__ - -------------•---•- SEEPAGE PIT ( Depth ------ 5------- Diameter ---- 3"-E-- Number --------�------(--------- Rock Filled Yes [ No Water Table Depth ------------------C-P--'---------------------Rock Size -- 1« - -3 N Distance to nearest: Well -----------ho-4__r__________________Foundation ---.Jr-V---------- Prop. Line ------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------•------------------------------------ Date ---------------------------------- Septic ------------_----__---------- --Septic Tank (Specify Requirements) ------------------------------------------ Disposal Field (Specify Requirements) _____.__-_ --------------- -------------I------------------------------------------------------------- --- ---- (Drow existing and required addition on reverse side) , 1 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 issuedr I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- ------------------------------ -------- Owner --- - ---- --- f BY -------- ----- -------- ----- -------- -- �! -----t - - -- :-"r -- ----- - Title ----Q- (If other than owner) - FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BYBUIL --------------------------------------------------------------------- DING PERMIT ISSUED --------------------- ------------------DATE --------------------------------------------------------------- ------------------- ADDITIONAL COMMENTS -------------------- ---- - -- --------------------------------------------------------------------- --------------- ------------------- -- ------ -- ------------ ----------- ------------I--------------------------------------------- ------- --- -------- --------- Final Inspection by: _ _ ----------------------Date `7/ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M.