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AOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ---------------------------------------- _ ------ - "`- --This'Permit Expires ] Year From Date Issued Date Issued Application isohereby made to�the San Joaquin Local Health District for a permit to construct and install the work herein described. Th is,app_l.ication Js,,made i0_compIiance =CountyOrdinonce No. 549 and existing Rules and Regulations:. J , _With JOB AD ;R€SS/LOCATION- -! = - _- -----�V--=----� l _ AJ--------- D------- ---------CENSUS TRACT .��-� �.---- Owner's Name .-- - `z---::_I- -►�__!_C1U_yo------------------------------------- Phone - '�r'- a � ---- Address � L16 � W----__.��._� fr-, 2----------------------------------------------- City 1��T�`� ---------------------------------------------------------- A --------------- ----',-=------------------------------- ./ _ &• _3-7" Installation Contractor's Name 12. �` '-----------------------------License #� 1�� --- Phone --Y_:3--- Installation will serve. Residence ❑ Apartment House❑ Commercial : Trailer Court f;(] C f Motel ❑ Other ---- # Number of living units:--- Number of bedrooms _ .-___Garbage Grinder ------------ Lot Size l �� ------------------------------- Water ----.-- _____________ Water Supply: Public System and nam-ems ---- -" ----------------------------------------------------------------- -------------------------------Private . Charadter�of soil to a depth of 3,,feet` Sand•; Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam;❑ Hardpan E] Adobe�iF 11 Material ___.-------- If yes, type _________________________ __ W. (Plot plan, showingrsize of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) ` N NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I I SEPTIC TANK. Size--------------------------- .------------ Liquid Depth -------------------------- i Capatit Type _ aterial______ __ No. Compartments �. i y -;-- ---------- yp. ---------------- ..,�. p Distance to nearest: Well ------------------- --------------Fou dation ---------------------- Prop. Line -----------_----_.._._ LEACH NGG LINE [ ] No. of Lines -----I----------------- Length of each line---- ------'---------------- Total Length -----------.---------------- 'D' Box _______._.__Type Filter Material __________________ pth titer Material -------------------- __ -----___ ____ Foundat on Distance.,toj nearest: Well ---------------- - ___- ------.___ Property Line -------,_.-__-_-__-_-_-- t~ SEEPAG PIT [ Depth __-____ Diameter _____ __________ Num r __-_.__._._-___-_ __________ Rock Filled Yes No ❑ f Water Table De -- --- --------- --------- ----•---• - _Rock Size --- �------------=------------- �Dastance to�nearest:�Weld-�----- -------------------- ------FoundationF------------------e Prop. Line ---------------------- REI _-- REPAIR/.ADDITION(Prev. Sanitation-Permit# __ - -------- -- Date f_________________ _) 1 _ _ - I Septic Tank (SpeciTy Requirementsf ------ --------------------- ------ tt Disposal Field (Specify Requirements)-i ---__----____________________•---------------------_ _ -- i - --- ------------------ - --- --- i ----------------------------------- = J, -- _ - - --- (Draw existing and required addition on reverse side) — '- I%hereby certify that I have prepared this appliccl n 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, 1 shall not employ any person in such manner as to become subject to Work 's Compensation laws of California." 3 ._ Signed . ---- ------------=- - Owner t By -"-- -- --- -- -- ---- , Title --'-- ---- "--- -- -- ------- --------- -- ---------- --- -------# (If other than owner[ , FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ------------------------------------------ '~� -------------------------------------- DATE : ----=---------------^- ------ .. -=� BUILDING PERMIT ISSUED. --------------------- -------------------- --DATE --------------''------------------------ ADDITIONAL COMMENTS --------- ---- - ------------------------------------------------ - :--"'------ I---------------- - ---`------------------------------------- -------- , ---------------- ----- - -- - Final Ins ec------------------ --- -- -------- - ----------------- ------ - , i w ------------------- ti ----- -------------- --------- ------- --- >- - ---- - ------------- o- as r "//� ! r p -- �- � -��-� --- ---- ------- ---� _ � --- ----------------------------Date -- " --- ----------- - : �- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -