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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- ------ ------- �- - - .�. . _ w ------ - " �� •:#Co"mplete in'Triplicate)^ 4 ` � ti� Date Issued _ �- This Permit Expires 1 Year From Date`Issued Application is hereby made to the San Joaquin Local Health District for a permit°toconstruct and install the work herein described. This application is made in compliance with County Ordinance 06. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __ _ 't_-- 1-- � L - CENSUS TRACT ----'---------------------- Owner's Name -�"Z"� C ��---- ---- Phone ��17J_2 �-- City -------------------- -------------------------------------------------- Address - -- - - A41 - -- ---------------------------------------• ` - License # /?�T�-_- Phone Contractor's Name .-11�CL7—_ `C %�1 _, w: r Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court i❑ ` Motel ❑ Other ---------------------------------------;,--- Number of living units:--- 1------ Number of bedrooms --_/ __Garbage Grinder. ./VO.- Lot Size .. _• -------------- i Private ❑ Water Supply: Public S m and name ------------------------------------_ _-- -- - Character of soil to a depth of 3 feet:.; Sand'[] Silt ElClay El ;Peat F1 Sandy Loam ❑ Clay Loam]] t Hardpan ❑ Adobe'N Fill Material ------------ If yes, type ----------------- ---------- ,s (Plot plan, showing size of lot, location of system in relation to.we1Is,_buildings, etc. must be placed on reverse side.i �) NEW INSTALLATION: (No septic ;tank or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT [ ] S1 PT IC TANK'f I Size--------------'- -----------------•------ ---- Liquid Depth --------------------------- 13N Ca acit -- Type -------------------- Material---------------------- No. Compartments Distance to nearest: Well ------------------------------------Foundation ---------------- :,--.Prop. Line ---.----.------------- I --------- Length of each line-------- ----------- -- Total Length} -----------.- LEACHING LINE [ ] No. of Lines --------- g ------ 'D' Box --- - - ---- Type Filter Material --------------------Depth Filter Material ---------------------•----------------- Distance to nearest: Well ------------------------ Foundation ----:-------------------- Proper- Line ---- -•--•----•-••-•- - ,) SEEPAGE PIT [ ] Depth ---- -------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes f] No i❑ WaterTable Depth ------------------------------------------------Rock Size ------------------------------- I dation ---------------- Pro Line -----------_--------- Distance to nearest. Well ----------------------------------- -- Foundation - - --. p' } ItEPAIRfADD1TlON{Prev. Sanitation. Permit __________________________________ ------ Date -}.-------`f l ------------ I . Septic Tank (Specify Requirements) ---- ----------------------------------------- ----------- r - Disposal Field (Specify Requirements) -------- _ _ ---- 5 �` •i. ... - _ -------------------- ---------------------------------------------------- ------------------------------------------------------- _ _ _--_____- ---- --____-__- --___---_- ______________ ____________ __ -_ _ -------__..______._____--______..____-__,_____.___-___.__________..--__________-- - - 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 I as to become subject to Workman's Compensation laws of California." Signed ---------- ----- ------------- I- -- -- ------- --- ----------------------------- Owner Bt - ------- -------- BY ---------------------- ------------------- Title (If er than ow r) i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE 7 - -- --------------- BUILDING PERMIT ISSUED ----------------- --------DATE -------------------------------------------- ------------- ------------------------------ - - ADDITIONAL COMMENTS ---------- --- ----- �' - T ,1G -------- -�---- ------/---- --_U- -------------- ----- } 'r - -------------- ------------- - -- -- ------ Final Inspection b Date ____ _ _._;{ -- -- - ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M