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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT // c -..... Permit No. /�� + (Complete in Triplicate) ...... .................. This Permit Expires 1 Year From Date issued Dote 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 in compliance with aunty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO � . . --. - .— -- _ . TRACT Owner's Name . Phone 222 •- ' - . ------------ ------•-•-•---- Address 7.. .- ;! "' ."^""? �'"�,� � city ........`....... ........................... Contractor's Name .... --------- --- .:. :........_. I g3�Y . ...license # •--._.... --_....... Phone'..., . .. . Installation will serve: Residericq JC Apartment-House -Commercial=❑Trailer Court 0 .Motel ❑Other ------ ...... ------------ Number of living units ...... Number of-bedrooms Garbage Grinder....... Lot Size .............. .. __- Water Supply: Public System and name --------------------_---:...............:...F-----------_:-----•-•----:-------------•. ................ Private Character of soil to a depth of 3 feet: Sand[] Silt 0 -Clay ❑ Peat C] -'.."Sandy Loam V Clay Loam 0 Hardpan E] Adobe 0 .Fill Material ............. If yes,type .................:.:........ per, V (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............................................-..__ Liquid Depth .......................... Capacity .......:............ Type ....... Material--------------......... No. Compartments ................. Distance to nearest: Well ......................................Foundotion ...................... Prop. line ................. LEACHING LINE [ ] No. of Lines ...._.................... length'of each line-------- ------:......... Total Length ............................ D Box Type Filter Material -- Depth Filter Material Distance to nearest: Well .................. Foundation ....._................•--- Property Line ........................ SEEPAGE PIT [ ) Depth ___-__-•_- -:... Diameter .............:.: Number ......................-::-.. Rock Filled Yes ❑ No �] • Water Table'bepth ...................Rock Size ..... ...... Distance to nearest: Well ..................................,.....Foundation ..................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ..........:................................. Date .................................. Septic Tank (Specify Requirements) .....---•--•-----•--------------------------------� :.. ..................... .....--------.... .. _.... •------ . •-- Disposal Field (Specify Requirements) �'^- �*-- , r -- -- ------------------ •-----------------------•-----------•---..-............ ------------------------- ---------------------------------------- (Draw existing and required addition,on reverse side) 4 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 liven- 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 mpensatio'n s of California." Signed " `Owner BY ....-- �= .- ',Title ..:. -�... .-..-:... ; (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED . - � ! %!r ..--------•------ . DATE __ 4`] "f:' ------ BUILDING PERMIT ISSUED ...................:..... .:: .............. ......................:....................• :......:-----.....--•-DATE ........................................... ADDITIONAL COMMENTS ' -------------------------------------- t. -------------•-- ......-...:---=-----==--------• :.:.................------=---._._.....--•--:..._.......... --=---_.._.____.------- € ._ --•-------------- •. ...... _ ...........................• ._._----- - --*.......----- ........................................_..---- . ----- -. ••..2_................ .......;. . ........ Final Inspection by:� r."' �' ,. - '�' • - =- -..._.. - Date L I SAN JOAQUIN LOCAL, HEALTH DISTRICT 13 24 .-.., __ c E. H. 1-'68 Rev. 5M 7172 3 M