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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 _._C-`a= _�a Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in-compliance with Coy Ordinance No. 349 andX ssttino Ruled andReg iatioil�r JOB AD SS/L CATION .._. - re, �1.- -- ------------------ --------- -- ` ------- --------CENSUS TRACT ----------- --------• ---- 74 t -----Phon( Owner's Name --- ---- -- - l I all Address __ __ --_ - aG� tP A ---- r--- - - - r{N -- - i-----------. City - -- -- -- ---------- ---------- �V_ J Q ? a 4r Contractor's Name �- --- _ - _ _A __ _. _.-_�__S -6J'i'r_____.License #IQOy PhoneJ4Q_"�V.-�_ Installation will serve: Residence ❑Apartment House❑ Commercial []Trailer Court ;❑ Motel ❑Other --------------------------------------------- f Number of living units:.--1-.------ Number-of bedrooms-------Garbage Grinder ------------ Lot Size _, Q-�_J _j--.__-__.__ Water Supply: Public System and name --`----------------------------------------------------'-------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam K Clay Loam ❑ k Hardpan ❑ - Adobe ❑ Fill Material ------------If yes, type ____________________________ I (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,] W PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth _.------------------------ Capacity -------------------- Type --------- - -------- Material---------------------- No. Compartments --------------------- Distance to nearest: Well ------------------------------------Foundation------------------------Prop. Line _____.________-___ r LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total L'ength ----____.___________t______. 'D' Box ---------.-_ Type Filter Material __._____-------- Depth Filter, Material --------------------------------------- Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ________________._._.___ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled " Yes' ❑ No C] . Water Table Depth ------------------------------------------------Rock Size -------------------------------- D stance to nearest: Well ------------------------- ..Foundation -------------------- Prop. Line ----------_---------- REPAIR/ADDITION .-_______________ __REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------e-------------- Date ----------------------------------1 Septic Tank (Specify Requirements} - -' - _ ----- -------•------------- ------ - J D' posal ,Field (Specify'�Requirements) ----.�------ - _-- ,t�_ -- _� _� A-__.�`--- -- -- - I/ g' T a i C f --- - -------- - ------------------- ------------------------------- } �1------- --------------------- - - ------------------- -----.__------------------ (Draw exi!*ing and require addition on reverse side) I hereby certify that I have prepared this applicationIand that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son. 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 , '------- -------- ------- - ------ 11PARTMENT ---- ---- ------- ByTitle --------- ------ -------------- -------- ------ -- ------------------ SLPTidf-PA h� ± 2915 E.Miner Ave., • H0.&3841 _FOR USE ONLY APPLICATION ACCEPTED BY ----------------------------------------------------------------- DATE - --f "---- ----------------- BUILDING PERMIT ISSUED ---_ --------------------------------------- ----------------- ----------------------DATE ------------------------------------------- -- ADDITIONALCOMMENTS ------------- --------------------=----------------------------------------------------------------------------------------------------------- ----------- ------------ ------------------------- ------z---------- --------- ---- ----- Final Inspection by: -------------------------------------------------------------------------- ---Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M :e,6.7-3d!5Z l