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FOR OFFICE USE: .� APPLICATION FOR SANITATION PERMIT w - --------------- _ ` � -5_ � Permit No _______________ _ (Complete in Triplicate) A�►`�P--------------------- This.Permit Expires 1 Year From Date Issued 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: i. / ��jj JOB ADDRESS/LOCATION f/ -4... --- - ------ CENSUS TRACT i Owner's Name --- ^ --- Phone-V6u�-r�02ee P-_---- 1 ---`---------- / ----- ----- ----- -- ------ - Cit------- ------- Address - ------------ -- -- ---- -- Y - -------------------- - I Contractor's Name ------------ ------------------------ - ----- -,.�-Cr LrP----=-=-------.License #IOV-5-11---- Phone Installation will serve: Residence House❑ Commercial:❑Trailer Court ',❑ Motel ❑ Other - ------------------------------------- --- Number of living units:___—/.___ Number of bedrooms ----!�arbage Grinder ------------ Lot Size __, _____ ___ ___ -------- Water Supply: Public System and name _______________ _ --------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt Clay E] . P 0 Sandy Loam ❑`�`Cldy Lo'a'm �] �° r Hardpan 0 Adobe Fill Material ------------ If yes,type i - (Plot plan, showing size of lot, location of syste rfi-in re ation t6-Wellsw-6uildings,etc -must-be-placed-on-reverse-'side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) � _ r PACKAGE TREATMENT [ } SEPTIC TANK'[ I Size------------------------------------------------ Liquid Depth ------------------ ----- Capacity `----------�--- Type ------.Material-------------- ------- No. Compartments `- Distance to nearest: Well ____________________________________Foundation --------- ----------__ Prop. Line ________________....__ t ---: Len ) `. g -----------�`= LEACHING LINE I' ] No. of Lines Length of line Dep#h Filter Mater al I Length _________- i __ � � � t. kc�� b 'D' Box ': ____ Type Filter Mcite.rial r__ -- h -n, F h Distance o nearest: Well -----------------------_ Foundation -------I__-_.______:___ Property Line ____________ _ .. # `tom A„ SEEPAGE.PIT [ ) Depth __ ________________ Diameter -------________. Number ---------------.------------ Rock Filled Yes ❑ No 1 1 Water Table Depth -----_- --- Rock-Size----------------------- ------- Distance to nearest: Well -----------------�/-,_-------------Foundationo_l'-------_ -- Prop. Line --------------- REPAIR/ADDITION(Prev.(Prev. Sanitatioln Permit# ____________________________________________ Date -________ _____________________�-) I Septic Tank (Specify Requirements) -------------------------- ----- - --- -------- ------- ------ ----- . -----•-- Disposal. Field {Specify Requirements) ------- - -- -------------------------------- --- = 3 % a _ r' �= ` -------------------------------------- -- -- � �`'a��------------------------�--- ------------------------------ti 1-- - - = "I (Draw existing:and�aired addition on reverse side) 1 ' 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 Healih;DistiilcV, Home. owner or licen- sed agents signature certifies the following: -- "I certify that in the performance,of the w00 this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws'of California." � " fA � kSigned --------- ----- ------------- ------ - ----19--t-4 - - --- - -------- ------------------ - Owner------ Title ---- ----- 1BY -------------- r - - --------------i------- (If of er owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -.-, -- -------- ------------------------------------------.------------- DATE !�_1:Q- `' --------- BUILDING PERMIT ISSUED -------------------------------------------------------- -------DATE -------------------------- - ADDITIONALCOMMENTS ------------ ------------------------------------------------------------ ---------------------------------------------------------Lq-------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- - ------------------------------------------------------ --- -__d------- - - --- - S Final Inspection by: ----- - Date --------------D - l SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M