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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ---------- --------------------------------------------- (Complete in Triplicate? _ --------------------------------- ------------------- --- Date Issued �-7---• '� This Permit Expires 1 Year From Date Issued Applica'fi'on is hereby made to the'San Joaquin Local Health District for a permit to construct and install the work herein 1cation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: r described. This�°appl' ,t " JOB ADDRESS/LOCATION 3. J_ZZ--- ---- - y'f2 CENSUS TRACT Owner's Namejp f -/�-/ ,, -------/��7ff� llS + L ----Phone = i 1 L.ci Cit ? C�� ------------------------------------ Address - �_� '7 s-S � Y t - Phone 3- -'----------- ------------------ ` Contractor's Nam `- �/�� License # / Installation will serve: Residence,[] Apartment House❑ Commercial []Trailer Court �❑ Motel ❑ Other --__- --- L'- Number of living units:-.---.--____ Number of bedrooms ------------Garbage Grinder _---___-___ Lot Size -_�---��-"�`-�,----- , y i I Private Water Supply: Public System and name -------------_- ----- P _r: 7 1 haracter of soil to a;;de th of 3 feet: Sand'❑"" Sit#❑ Clay ❑" eat❑ Sand Loam❑ Clay Loam ❑ � Y 4 IiI Hardpan ❑ Adobe Fill Material ------------ if yes,type -------------------------- J --------------------- --- n showing size'of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ' (Plot pla 9 NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,} 4 , Size-- � ti�-- , 'Liquid Depth j� PACKAGE TREATMENT { ] SEPTIC TANK![ ] /// No. Com artments -_ .---------•• Capacity ��/a�o.- Type--- Material p , Distance to nearest: Well "ib - _�- -.------ --- Prop. Line _--_--__------ -_-_ t --- Length of each ,bine -- 70- Total Length __ -/Sp-- LEACHING LINE [ ] No. of ,Lines --------------_____- 9 �---- � �� c% i D' Sox -----__.--_ Type Filter Material ---- -- -----------=Depth Filter Material -_/1--____-___------------•------•--•- " F (- - -- Foundation Property Line ------'------------- Distance fo nearest: Well _ �----- - /©------- SEEPAGE PIT [ ] Depth .-_�_�_ -------- Diameter 3� _----/Number - -_ .-- ----- Rock Filled Yes 19 No C3" Water Table ,Depth --------- ` Rock SizeC��------------ 1 � -Foundation l_d------------ Prop. Line ---- a� Distance!to nearest: Well __-_ --------------- `1 Date -------------------------- REPAIR/ADDITION(Prev. Sanitation Permit# __-- ------------- Septic Tank {Specify Require�n fnts] -------- - - Disposal Field (Specify Requirements) ; -------------------- ----------------------------------------------------------------------------------------------------T---- ------------ -------------------- - ---- ---- -- ---------------- -------------------------------------------- F - ------.---- -------- ---- - - (.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 r as to become subject to Workman's Compensation laws of California." Signed ---- --- - --------- - - ;>--�-------- e -------------- Owner - Title --------- ------- - Y ------- ---- --P- -- --------- ------------------- -------- (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_ ----- '_ ___-- '� - � DATE .- J� �- - - -- Jg _DATE - ----------------------------------------- BUIL ---------- ------------ -------- -- ----------------- ------ --------- t BUILDING PERMIT ISSUED ---- -------------------- -------------------------- ADDITIONAL COMMENTS --------- -------------------------------------------------------------- --------------------- ------------- ---------------------- -------------------------- ------------ ------------ -------------------------------------------------- - - - -- ----- Date ----- --�- ----- ---- ---- - Final Inspection by: -------------- _ _ _- - i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68,Rev. 5M