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fQR'OFF.ICE USE: a APPLICATION FOR-SANITATION PERMIT , Permit No. (Complete in Triplicate) -----=------- ---------- ---------------------------- p f Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 4 described. This application is made in compliance with County Ordinance No.. 549.and existing Rules and Regulations: JOB ADDRESS/LOCATION ----��_� =--- ---------------- -�-' - -------------- ,-CENSUS TRACT -------------------------- 14 G)q 7,Name - rZ1!_I_ - Phone _ _� - -- --------------- �'�-'`-' ----------------- -----------------------i----------- ---- _=-.-------- - Address ---------- ---------- - - ,i . City _ --------- --'- ----------------------------------------- ---------- ----------------------- ---f---•---•=• Contractor's Name __�--------------------------------------------- --------- ---------License # = ------------ Phone - "`+ i Installation will serve: Residence [ElApartment House❑ Commercial ❑Trailer Court. !❑ Motel ❑Other ----------------------- -------- Number of living units:__. w. y t ► 1 �® c� . ._ Num'ber. of edrooms _a__-___Garbage.Grinder _�:___-____ Lot Size _:____ ___ ___________________________ Water Supply: Public System and name _____ ____Private ED Character of soil to a depth of 3 feet: Sand,❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe V Fill Material ------------ If yes, type ____________________________ F (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) QD PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth --------------------.----- CapacitY ------- --- --------- Type -------------------- Material----C------------ No. Compartments -------- Distance to nearest: Well ____________________________________Foundation - -------------------- Prop. Line __-_________:__....-- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line----------_----------------- Total Length ------------ ----...---.-- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -----------------------'------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. ---------_------------. SEEPAGE PIT [ Depth -c-V.. Diameter a�__- _-- Nura7ber .----------4---------------- Rock Filled Yes No 0 ¢` Water Table Depth ----------------------------- I----- -------Rock Size ------------------------------=- j Distance to nearest: Well ------T-3_14'----►------------------Foundation ____________________ Prop. Line _____.-.__._____-____. REPAIR/At)DITiON(Prev. Sanitation Permit# --------.---------------------------n------ Date --------------------------.-------I SepticTank (Specify Requirements) ------------------- --------------------------------tn----------------------------- -------------------- :-.----------------------•---- Disposal Field (Specify Requirements) ____________ ----------- --------------- --------------------- '---------------------- ------------------------------------------------------ ----------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this applicationEand 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 "I certify that in the performance of the work for which4his permit is issued, # shall not employ any person in such manner II as to become subject to Workman's Compensation laws of California." Signed ---- / [If ather than -------------------- ------------------- Owner Title = owner( l ) FOR .DfPAIIITMI:NT LlSE ONLYAPPLICAT1 ----------------------- BUILDING IOPERMIT CEPTED ESSUED BY -- as = ti �:.rirx 4 �c_::_ �w DATE --------�-�..".�-----�p-�------ ----ATE . ADDITIONAL COMMENTS- +- - ` -� `o - ---------------------------- --------------- ----------------------------------------- ---------------- ------------------------- ---- --------- .�° Final Ins ection b �"` ----------=='------------ Date -7 �r p Y. _ ___ _ SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H. 9 1-'68 Rev. SM / 5 . a � , „ ,. .,.R, s,. J i