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fOR OFFICE USE: 2 D _ APPLICATION FQR SANITATION PERMIT (Complete in Triplicate) Permit No. -------------------------- This Permit Expires 1 Year From Date Issued Date Issued ---- 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 incompliancewith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .fLI-------------------------------CENSUS TRACT ---------------------_--- Owner's Name . . X16--1V_'C------------------------------------------- ---- --- Phone --------------- Address _3_97Z. ----- 4-O-C k, �- -------. City F/�e�C� -� -p-----------•----------•------ f Phone __ Contractor's Name ....�--� ��'��-�--- -� - -----------------=-=-------.License ��-------------------- � 3__.:�G - . Installation will serve: Residence 19 Apartment House❑ Commercial :❑Trailer Court ;Q I Motel ❑Other -------------------------------------------- Number of living units_____________ Number of bedrooms _______Garbage Grinder __________ Lot Size --15 _> __ -7_a ........... Water Supply: Public System and name --------------------------------- ----------------------------------------------------------------- ---------Private Character of soil to a depth of 3 feet: Sand'p! Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Mciterial ------------ 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 p blit sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK f ] Size__?`_ _ nn.�� .6__--------- Liquid Depth _ __________,___. Capacity 1. OAO--.--- Type _ _Materia F_- No. Compartments -9---------------- Distance to nearest: Well -----15--o__________________*__Foundation -1-k-------11----- Prop. Lined.----- LEACHING inesem? ____LEACHING LINE [ ] No. of Lines ------:R-__------------ Length of each line__._.f_0_C7-- ------ Total Length r r� D' Box ------------ Type Filter Ma��tcceria! -�a--- ---Depth Filter Material -- /y` ------------------ ------------ Distance to nearest: Well ------c7__a1----- Foundation --_CD_'r__________ Property= Line �1 ___ Rock4Fi,�d Yes ❑ No i❑ SEEPAGE PIT [ ] Depth ____.__ ---- Diameter _______________ Number ___________________:_ _ �' Water Table Depth ---------------------------- -------------------Rock Size --------------------------------- Distance ------------------------- -----Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line _.._.____-________--__ REPAIR/ADDITION(Prev. Sanitation Permit* -------------------------------------------- Date ---_-----------_--.--------------_) SepticTank (Specify Requirements) ------------------- -----------------------------------------------------------------------------"----•--------, ----- --------------------- DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------- --------------------------------------- . Q --------------------------------------------------- - ------------------------ ------ ------- ------------------------------------------------------ ------------------------------- (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, 1 shall not employ any person in such manner as to become suble to W kman's Compensation laws of California." Signed ....... .......................... -- .---------------- �1 Owner By --- -- - - Ti ------------- ----------------------------------------------------- (If other than owner) t w FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE _ef3/�?�'-------------------------- BUILDING PERMIT ISSUED ----------- --------- - ----DATE - ----------------------------------------- ADDITIONAL COMMENTS - --------------------------------------------------------------------------------------- -- - 11----------- --- --------------------------- ---------------------------------------------- ---- ---------------------------------------------- ------------------------- ----------- ---------------- -------------------------------- Y - - - --------- Final ------------------------------------- j Final Inspection by: ---- ---------------------------------------------------- -Date �iA° - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M