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I= R OFFICE USE: APPLICATION FOR SANITATION PERMIT ��' d Permit No. ,,- .- {Complete in Triplicate) ��- - � --_ - _-------------- This Permit Expires I 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 Reguldtions: •7 JOB ADDRESS/LOCATI ��716 '----------------------- --.--CENSUS TRc�ACT -------------- ----------- JOB ---------•- Owner's Name --- U �lt.Q.� ----------------------------- ------------------Phone $t� { Address --------------- ------- ------------------------- City --- ------------------------------------ ------ Contractor's Name ------ .y�L --------------------------------------License # -------- ----- - -- - - Phone 6 ----_-- Installation will serve: Residence 9 Apartment House 0 Commercial :❑Trailer Court k❑ xMotel ❑Other -------------------------------------------- Number of living units-----/------ Number of bedrooms - Garbage G inder0_ , --------- Lot Size ----------------------------------- -------- k Water Supply: Public System and name ----------------------- y -- Y/ ---- -'--- Private ❑ fCharacter of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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 INSTALI:ATION:-- "(No`septic-tank-orrseepage-pfit permitted,if-public'sewer-is-available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'{ ] - Size---------------------------------------------- - Liquid Depth -.-------------------.----- capacity ------>--------- Type --------;;-m; Materia --------""""------- No. Compartments -------•- ------------ ,.. .4 4.; Distance to nearest: Well --------------- --- --------------Foundation ---------------------- Prop. Line ---------------------- - � LEACHING LINE [ ] No. ofAines.,.--------_-------------- Length'of'each line __-_------------- ------ Total Length ,--------------------------- 'D' Box ------- - - Type Filter Materiah _�---------------- Filter Material ---------------------------- 1-1 4L; t °f Distance to nearest: Well ------------------ Foundation ------------r' Property Line. ------------------_--- SEEPAGE PIT'S [ j ��w •Depth --�:-------------- Diameter ---------------- Number ----_----------------------- Rock Filled Yes ❑ No ❑ _u Water Table-Depth ------------------------------------------------Rock Size ------------------------- - MDistance to nearest: Well _____-_---__-------------------------Foundation Prop. Line ---------------------- REPAIR/ADDITION(Prev-Sanitation Permit -----------------------------`-------------- Date ------------ ------_--? Septic Tank (Specify Requirements)r-----.--____----- k-------rl__ Disposal Field (specify Requirementsi l n---- -- --`-- ---- - ------------- ----------------------------------------- -=-- �. aw I hereby certify that I have prepared rth s application and Ithata h ----------- existing q dition an reverse-side) e 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." t y.wrnnn. -0 Signed wrier� ------------------------- ZV-------- ---------- ------------------------ Title --- --- ----- 6*1' -------------------------------------- (If of er t an'owner) 1.� K 1 s FOR DEPARTMENT USE ONLY APPLICATION. ACCEPTED BY ----------- -----------------------------------------3------ DATE BUILDING,,PERMIT ISSUED ---------------- ,- ------------------------------------------------ ---------------- --------------DATE -------------•----------------------------- ADDITIONALCOMMENTS --- -----------------------17_"' ---------- --------------------------------------------------=---------- ---------------- j ✓r 3 --------'--------------------`------_------------------------------------'-------------------------•-p-------------------------------------{_------------------ -------------------------------- ----•- - - ----- Final Ins ection b lam'_- f _ Date P Y ------------ - 'SAN=JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M