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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' ------------- -------- ------- ----- ------------- Permit No. ----73.-,21-7 i ------------------------------------------------- I (Complete in Triplicate) I 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 y described. This application is n compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT ON -------- -- c x_560 ECENSUS TRACT -------------------------- Owner's Na G. I!`------- -------------------Phone ------------ ----------------------- Address _._ 0sQ � b�t� (/ 9" Contractor's Name _ _,.[� _ ____ ----- -----------License # / .. _ Phone i Installation will serve: Residence ❑Apartment House^❑ Co mercial ❑Trailer Court ;❑ Motel ❑ Other Number of living units:------------ Number of bedrooms ____________Garbage Grinder __-__---- _- Lot Size _.,,t, `' J________ Water Supply: Public System and -------- ------------•-------------�---- - ------------------- ------•------------------------------- ----PrivaXChaacter ofsoto depth of 3 feet, Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam .0 Clay Loam ❑ Hardpan ❑ Adobe-E] 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,) �Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------ __ !; / ---------------------- Liquid Depth .�_`a'y__---------.-•--- �, y Capacity ------ Type _ - _ _ Material___ o. Compartments ----- ..._.. t f Distance to' nearest: Well -------/C2_ ---------------Foundation ------------ Prop. Line ------47__._____ LEACHING LINE [ ] No. of Lines _______ --------------- Length of a ch line--------� ------------ Total Length __�C ............... // , ��sr !� D' Boxm`•J._ Type Filter Materialll__ �yrDepth Filter Material -___.1 -------- _ - `Q---------- Property Line. ------`-S..---••- I Distance to nearest: Well -----`a';�--------- Foundation ------___ , SEEPAGE PIT [ ] Depth Z --- Diameter...-_;-a3----- Number -------/----------_------ Rock Filled Yes No C]1 f r Y Water Table Depth --------- --___--• ---------------•---Rock Size __- -f X � - r r � � r Distance to nearest: Well ------IU=1�)----------------------Foundation ---e"`6 Prop. Line ._ - ...... , REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ------.--------------------------- Septic _---______ _Septic Tank (Specify Requirements) ------------------------------------------------------------------------------ = - i Disposal Field (Specify Requirements) ---•-------------------•-------------------------------------------------------------------------------------- ------ { -------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- ------------------------- ------------------------------------------------------------------------------------------------------------------- ----- ------------------------------- [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 sub' War an's Compensa ' n laws of California." Signed ------ --------- ___ Owner BY ------------------------------- ~� - ` Title (If other than-own ----------------------------- � FPR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY Y - - - ---------------------------------------------------------------------- DATE ----- � 0------------ BUILDING PERMIT ISSUED ------- DATE ADDITIONAL COMMENTS --- --- `-�- ------ - ..-------— ------------------------ --------------------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------- ---------------------------------------- -- ------ - --------------------------------------------------------------------------------------------------------- _ y Final Inspection by: = --------------- ---------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M