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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 :9! 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: SCAc-o JOB ADDRESS/LOCATION .--- _g ----------- -'-- 6 ---------------- ----CENSUS TRACT ------6------...--_---- Owner's Nam - ----------------------- -------------------Phone -------------------••---------... Address ------'Z-1_SO -. _ -- - City 1=1= CfiL�/1� ----------- -------------------1--r------ ----------- Contractor's Name .- ---- ---- � icense #401;2.3-77--- Phone Installation will serve: Apartment House❑ Commercial :❑Trailer Court I❑ Motel ❑Other Number of living units------ ----- Number of bedrooms _-J-----Garbage Grinder -A10__ Lot Size __IS 000- f7 --------------- Water Supply: Public System and name ______________________--_ --------------------------Private Character of soil to a depth of 3 feet: t Sand [] Sift❑ Clay 5Q Peat❑ Sandy Loam .❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _M' 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,) 1 PACKAGE TREATMENT [ ] SEPTIC TANKf ] Size-�X�__-x. 13----------------- Liquid Depth -----------____-- --• _ - Capacity _.�. d_Q -- TYpep _- _I3Material_�q� No. Compartmentst�—h.. ` - Distance to nearest: Well ---L-4-I--------------------------Foundation J-b-------- --_---- Prop. Line ----------- LEACHING LINE [ ] No. of Lines ----�------ ------- Length of each -------------- Total Length _-:..-_.______ 'D' Box ----1------- Type Filter Material -__ ___ _ _Depth Filter Material ________._____________________ Distance to nearest: Well _-_ _�______________ __ Foundation _._ _ .D -_________ Property Line -__ �__r._______.__._- SEEPAGE PIT [ ] Depth JI-1--------- Diameter 7_`_X �_ Number -----.12- --------------------- Rock Filled Yes ® No ❑ Water Table Depth ------------------------------------------------Rock Size --- ---��- -------------------- Distance to nearest: Well _h-Q_ ----------------------------Foundation o2D--______-_.__ Prop. Line -Ip________ ------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______-___-_______________-______) Septic Tank (Specify Requirements) ----------------------------------------------------- Disposal ---------------------------------------------------Disposal Field {Specify Requirements) ----------------------------------------------------------------------------------- ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ (Draw existing and required addition on reverse side) I 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 becorfte subie �lllorkman's Compens iAn la s alifornia." lI Signed ----- Owner BY --------------- - -- - - ---- - - - - - ------------------------- ------------------------ Title -------- -- (If other than owner) p FOR DEPARTMENT USE' ONLY APPLICATION ACCEPTED BY -- -� n---rv-------------------- /7-- --- ----------------------------- ------------- . DATE BUILDING PERMIT ISSUED --------------------------------------------------- - --------------DATE ------------------------------------------- -- -------------------- -=ADDITIONAL COMMENT ----------------------------------- ---------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- ---------------- --- FinalIns b --------------- ------------------------------------------------------° P___ Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M