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FOR OFFICE USE: ------------- ---------- APPLICATION. FOR SANITATION PERMIT S, -------� g Permit No. - ------------- - - � �,----- -'_�� (Complete in Triplicate) ------------ --------- ------------------------ This Permit Expires 1 Year From Date Issued Date Issued r 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 Regulations. JOB ADDRESS/LOC TI N /- � -_.CENSUS TRACT Owner's Name ---- - ---------------� ry ------- ----------------------------------- Phone 94-Ir-3:312,§----------- Address ------------------ ----. city $` °6-------------------------------- -- --- - ----------- -- - Contractor's Name -----------------.License Phane&-Fp7----------- Installation will serve: Residence Apartment House-F] Commercial ❑Trailer Court ❑ Motel ❑Other ------- ------------------------ Number of living units:-_I------- Number of bedrooms ---T<"-_Garbage Grinder Lot Size 6?12-K-1__ -0---_---__.____ Water Supply: Public System and name ---G4- St— - -�.R----------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'C Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ AdobeV 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth -------------------------- 4.X Capacity --------------- _------ Capacity -------------------- Type -------------------- Material------------- -------- 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 -------- ---------- Diameter ________________ Number -------------------------.-- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------ ------------------- Date ---------------------------------- Septic ____-_____-..___-_____________Se tic Tank (Specify Requirements) -_-..-_-____-_____.- ZDisposal Field (Specify Requirements) -- (/___ , _ (((fff - ----------------------------------------------- - - ------------------------ - - - -- ------------------------------------------------------------ (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 f . which this permit is issued, 1 shall not employ any person in such manner as to becom su ject to �+Vo an's Compens ' laws of California." Signed --------- -- t'---------- M=7, Owner By ------- --�-`------- ------- Title ------ - - - - - - - -------------- (If of er than owner' '}�I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I/v- kV ----------------------------------------------------------------- DATE .---- ------------------- BUILDING PERMIT ISSUED --------------------- -------------------------------------------- --- --- ----------------------------- ---------------------------------------------------------------------------- -------------- ADDITIONAL COMMENTS - ---- --------------------------- -- -- ----- - - -------- ------=--------------- ------- --- ----------------------------------------------------------------------------- ------ ---- --- ---�-- 5 -G-S--------------------------------- r -------------------------------------------------- -�_ ---------- ---------- ----- --------------------------------------- --- ; ---------------- -------------------------------------------------------------------------------------------------------- ----- -- --- -- --------------------------------------------------- Final Inspection by: 14U1t+ --------------------------------------- ate -.-- ' �,- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M