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tr -� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _ ----��_-_ ] -------------- - --- " (Complete in Triplicate) --------- ---- ---- -------------------------- _ --- -_ ! This Permit Expires 1 Year From Date Issued Date Issued - _ � Q Application is hereby made to the'SariRJoaquin Local'Health-District-for-a permit to construct and install the work herein described. This application is made m compli ce with'County Ordinance No. 549 and existing Rules and Regulations: ....f `--------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATIOl Owner's Name �.t1 ------------------- Phone 7�-: �� i ------------ q Address ---- ------------------ - ----- l =------. — ----- City i --J of Contractor's Name Q~ �•p--- ----.License # AVSW------ Phone (!1 Installation will serve: ResidenceyApartment House,[:] Commercial ❑Trailer Court ;❑ Motel ❑ Other --------------------------------------------- �� ' �_ � Number of living units:____ __ _____ Number of bedrooms ____ -___Garbage Grinder ____._____-_ Lot Size ____ _ ____ ________ ----------- Water Supply: Public System-dnd name ------------------------------------•--•--------------------------------------------------------------- Private Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam .I] 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK{ ] Size----------=------------------------------------ Liquid Depth -------------------- Capacity - Type Material No. Compartments -----------------------C . Distance to nearest: Well ----=----------------------------------Fouridafiion ---------------------- Prop. Line -------------_--•.---- LEACHINGLIN EF [ ] No. of Lines -'----------------------- Length of each line-----J-. ------------ Total Length -----------.-----------•---- 6 1 _- _M ___•- �X D' Box_____________ Type Filterateria! ___________.___i____Depth Filter Material --------------------------------------- ` 4 Distance�to'nearest: Well ---- -'__i___ _ =___ FoundatioA ---------- --------------- Property Line ----------------_------ SEEPAGE PIT [ ] Depth Diameter " Number Rock Filled Yes ❑ No i❑ ------------- WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -----------------------------------------Foundation -------------------. Prop. Line ..-------------••---•- S I REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- Date --------.-------------------------) t Septic Tank (Specify Requirements) -- - -- ____,._ = = ----- ------------------------------- M ------------ Disposal Field (Specify Requirements) --- - ----- .. ---- ------ --• --------- a N -------------------------------------------- - ---------'--------------- - - = �� - -- i1 (Draw existingd rewiredY-?d- qdition on rev se 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.Laocal Health District. Home owner or licen- sed agents signature certifies the following: !+� 6_ . � "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:'- - - s Signed ------------ --------------------------_ -------- Owner ' ----------------------- ------------------------------ (If - T't1e ---------By oth an owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.. -- -- ------ DATE _L_Z .�- � ®----------------- -- --------------------------_ -------------------------------------DATE - --- ------------------------------------- BUILDING PERMIT ISSUED ________ ____________ ______ ADDITIONALCOMMENTS ----- ;- ---------------------------------------------------------------------------------------------------------------- t - -----=---------------------- ---- - , ----- ---- -- ------ --- --- -------------------- ------------------------ 4--------------- ------------------- -------- ------ ------------------------ ------------------- ---- ----- � _ A Final Inspection by. ---- -- ----- --- --- ----------------------------------------------------------------------------- - --------------------------- -----,Date -------- ----- - ---------- - ------ N DISTRICT E..H. 9 1-'68 Rev. 5M