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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- ---------------- -- Permit No: .7f3/� - {Complete in Triplicate} - -------- ------ r --------- __________________._.________--------------- This Permit Expires ] 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 madelin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �- rI � - -__ ------------------CENSUS TRACT -------------------------- Owner's Name - - --- -m�'!.f f Phone ------------------------------------ / 0 Address ------------------------------- City ,:� / -.7----------------------- -------------- Contractor's Name "____________________________________License # f��` -- Phone Installation will serve: ResidenceAApartment House°❑ Commercial :❑Trailer Court ;❑ Motel Fl-.Other ------------- ---------------------------- Number of living units:_______ Number of bedrooms __-------Garbage Grinder /r40--- Lot Size Z40/a- w'-__,8_ --------- Water Supply: Public System and name ----------------------------------------------------------------- --------------------------------------------PrivateX' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clby Loam ❑ Hardpan ❑Z� 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 { ] SEPTIC TANK'[] Size------------------------------------------------ Liquid Depth -----------------•---.-••-. Capacity -A --------------- Type -------------------- Material---------------------- No. Compartments ---------------------- Distance to nearest: Well -------------------------------Foundation ---------------- ---- Prop. Line -------------- . LEACHING LINE [ ] No. of Lines ------------------------- Length of each line---------------------.------ Total Length --------------- ------- , 'D' Box -----i----- Type Filter Material --------------------Depth Filter Material ------------------------------------- ------ Distance to nearest: Well ________________________ Foundation ------------------------ Property Line _____•--_____.____-_--_- } SEEPAGE PIT [ ] Depth _.____.I-___________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- i . Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line _____--___--__----_ REPAIR/ADDITION(Prey. Sanitation Permit# ____________________________________________ Date ---------------------------------- Septic _______.___________-____________Septic Tank (Specify Requirements) ------------------- l J ----------- --- � -------_ --- t -____-- Disposal Field (Specify Requirements) --- � __„. � ----------------------------------- --------------•--------- h ___________________________________________________ ______________________________________________________________________________________________________________________________________________ (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 Health District. Home owner or licen- 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 Compensation laws of California." Signed ------------------------ ---- --------- --- Owner - Title / BY � ------ - -- ----------------- {lf of han owner FOR DEPARTMENT USE ONLY ,r APPLICATION ACCEPTED BY __4f-__1Yr---- ------------------ ---------- ------ _------------------------------. DATE _ -3---7- .----------------- ---- BUILDING PERMIT ISSUED ----------------------------- ------------------------ -------------------------------- --------------DATE'------------------------------------------- - ADDITIONAL COMMENTS ___________________ _ �. i at 1 i ----------------------- --- --- ---------------------- ---------------------------------------------------- T" Final Inspection by:� �-- ----------------------------' Date -f N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M