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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT g --- ---- ------- ------- (Complete in Triplicate) Permit No. --- i----------------------------------------------------- Date IssuedL---_-7� l ------ This Permit Expires ] Year From Date Issued 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 County Ordinance No. 549 and existing Rules and Regulations: ------------ ------CENSUS TRACT -------------------------- � JOB ADDRESS/LOCATION -,-f- (.-{�� ------- - -�- - -��`-- -------------------' { Owner's Name �'4 - ' ----- -----.-Phone _ C-- ------ s - -? City -- Address ------------------------------� �-�---------- - -- ------- --- - - ----,-- - �------------------- ----�--- ... Contractor's Name = `=-----License # Q7.�a - Phone 7- . k Installation will serve: Residencey Apartment House❑ Commercial :❑Trailer Court ',❑ Motel E] Other -------------------------------------------- r t Number 'of, living units:------�_. Number of bedrooms --_-YGarbage- Grinder .._�'`-- Lot Size ---_f- -- - -u ---------•-- M11 Water Supply: Public System and name ------------------------------------------------------- -----------------------------•-'---------------------Private)K Character of soil to a depth of 3.feet: .Sand'❑ Sift❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam :❑ Hardpan E] Adobe' Fill;Aaferial------------- 14es,typ (Plot plan, showing iize of lot, location of system in relation to wells,'1`Idings, ,etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit permitted,if public sewer isavailable within 200 feet,) t ` PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size-----------------------------------•------------ Liquid Depth • z } Capacity Type --- Material---------------------- No. Compartments ------ ----- } Distance to nearest: Well -----_-----------------------------Foundation _y-."_ ----+------- Prop. Line --..-------__--------- LEACHING LINE [ ] No. of Lines z---------------- -- Length of Length :--------------------•-------- -----•- 1 Len fi o eachEne._-.�-_---_-._-� f D' Box -`--.-_-'--- Type Filter Material.=-------------- ----Depth}Filter Material--------------------------------------------- ^-- Distance.to nearest: Well ------------------------ Foundation•----.:---------------- Property Line ------------------- I i ' SEEPAGE PIT [ J Depth -- ":'__J--------- Diameter ---------------- Nurnber —------------------------ Rock Filled Yes ❑ No 41 Water Table Depth -----------•-----------�i----Rock.Size '---------- '` Distance-fo nearest: Well --------- ------Foundation --------------:------ Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -•---=-:.- R------------k-- -- ----------- Date ------- --------------.---------- -11q ---------) i 1 z.� stir ti 1q 1 £ _Septic Tank (Specify Requirements) -------------------------- fr-'-------f----- ---- -----k--- �---------- Disposal Field [Specify Requirements) ----------- = U - . - ---------- ------ I �-� f - i ------------------- ------------------------------------------- ------------------------------ J----------- :v ----------------------------------------------------------- (Draw - ------------------------------------------------ (Draw existingand required addition on reverse si el_,i. 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 Health District. Home owner or licen- sed agents signature certifies the following: "1 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." ;� I Signed ---------------- ------- ---- Owner ------ BY - �i�- =r Title ;------ ----------------------- ------ ------------- - (If other It"ho o ner) F E i FOR DEPARTMENT USE ONLY 7 , APPLICATION ACCEPTED BY --=---------- ---------------------- --------------------- ------- DATE BUILDING PERMIT ISSUED ............... ---- --- '--------- ---------------------------------------- --------------DATE ------------------------------------------- ADDITIONALCOMMENTS � �. --------- wD�---------------------------------------------------------------------------------------- --------------------------- i ------------------------------------------------------------------ ----------------- ---------------------------------------------------•---�------------------------------------- ----------------------- - -------- _ _ - -- -------------- Date -_ r, i �� Final Inspection bY: ' SAN JOAQUIN LOCAL HEALTH DISTRICT E.-H. 9, — 1-'68 Rev. 5M y.