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FOR OFFICE USE: APPLICATION FOR- SANITATION PERMITf/ ------------------------ (Coriplete Permit iin Triplicate) �/ /�Q ----------__---------------------------------------------- Date IssueF. _. ------------------------------------ _- This Permit Expires 1 Year From 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: ( ----CENSUS TRAM ------------ ----------- JOB ADDRESS/LOCATION .--,I -d�I --,-1 .__--- 11 --`c -------------------------- -------- Owner's Name _ / ---�L�_ 3 ��- ----- _ 7 � ------ Address �- � C - ------------------ Ci - qJ ane------------------------------------- V j Contractor's Name - — - � -ll-- �_R_ _____.License Phone - Installation will serve: Residence ❑ Apartment House❑ Commercial:['frailer Court ❑ Motel ❑ Other -------------------------------------------- ' Number of living units_____________ Number of bedrooms ____________Garbage Grinder ------------ Lot Size l2y ___.____-._.____ Water Supply: Public System and name• � ---------Private Character of soil to a depth of 3 feet: Sand'I Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam, Hardpan ❑ Adobe ❑ Fill Material ------- ---- If yes, type ---------------------------- (Plot __.____________________ _(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'[ l Size- --------------------- ----- ------ Liquid Depth ------------------------ Capacity ------------ -------- Type ----------------- - Material---------------------- No. Compartments ----------------------- Distance to:nearest: Well ----------------- _________________Foundation ___ ------------------ Prop. Line,_____________________ 00 LEACHING LINE [ j No. of Lines ------------------------- Length each .line-----------------.-- ----- Total Length .-------------------.......-- 'D' Box ------------- Type Filter Material -------------------Depth Filter Material ----------------------------------- -.-.--•- z Distance to nearest: Well __________________ _____ Foundation. :-°___ Property Line. ------------------------ F f. SEEPAGE PIT [ ] Depth ---___________----- Diameter -------- ------_. Number ------____.____ ___________ Rock Filled Yes El No Water Table Depth ------------------------- ---------------------Rock Size . #-----'-------------------- Distance to nearest: Well ----------------- ----------------------Foundatio --------------------- Prop. Line°,-----------•---------- r R i REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------- ------- Date _:_____ r ------------------------------------------------------------- ___._____________________ _________Sestic Tank (Specify Requirements) l -/^ ��--Di osal Field (S ecif Re uirements) ___ d �--- _------1-C2.?------ f-------- ---------- ---------- --- - 5 ,.I , --------------------------- --- ---------------------=°---------------E------------------------------------------------ --------------------------------------------------------- ---------------------- (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 Helth District. Hoene owner or licen- sed agents signature certifies the Following: t "1 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 subject to Workman's Compensation laws of California." >x Signeda Owner BY ------ Title --------- ----- - - - -- - ------- - F (If other than owner) rdI FOR .DEP TMENT USE ONLY 1. APPLICATION ACCEPTED BY ---- '. .� . ---------------- -------- ----- -----------• DATE ----- - 777p/--------- - BUILDING PERMIT ISSUED --- - � ---------- ---- - - ---------- --------------DATE -------- ----------"---------------------- -a � 7/ cAD - X-- vYr �lr. -------------- . ------------- -- -- -�------ ------------------------------------ --- -------- Final Inspection by; = C/ --------------------------------------------Date ------------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M F