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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT JD--4p� Permit No. -------------- -------------------- (Complete in Triplicate) --------=--------------------------------------------- - _________--------- This Permit Expires 1 Year From Date Issued Date Issued ____Jr_ 7_11__7 2 Application is hereby made to the an 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/LOCATION ._ 5e-7Qp --- ---- ----.f ------------ -- ------------------CENSUS TRACT ------------- Owner's Name ---------------------------------------Phone ----- _"r --- Address �� Z City --- ---- Contractor's Name -------- ------------------------------ ----4-1----- -------------.License # jf--- Phone 13---•X�0_ Installation will serve: Residencel—Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:__-- _ Number of bedrooms ___2��Garbage Grinder ------------ Lot Size ___________________ _ _ __-____.___._-_ Water Supply: Public System and name ---------------------- ----------- ----------------------------------------------------------$_%---------------Private) r Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ .ti Sandy Lbam Clay Loam E] Hardpan ❑ Adobe ❑ 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 [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -----------_------.-- Capacity -------------------- Type --------------•----- Material------------------ No. Compartments --------__ ---...---- i Distance to nearest: Well ______________----------------------Foundation 1-----y____._,,,_ Prop. Line __..__..._____________ 0 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 ______________---._.-____________1 Septic Tank (Specify Requirements) --------------------------------------------------------------------}--------------------------------=--------_---------------------------- Disposal Field (Specify Requirements) --------- -- J J t ��''''yy"JJ -------------- ------------------------------------------------------- ---------------------C. '' _ ----------- `�, -�"'"�--------------------- ' ----------------------------------------------------------- (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, 1 shall not employ any person in such manner , as to become subiect to Workman's Compensation laws of California." Signed ------- ----------- r --------------------------------- Owner BY ------ ----------------------------- Title ----- ------------ -=-------------------------- (if of er th owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------ BUILDING PERMIT ISSUEDDATE —'------------------------------ ----------- G 'r ---------DATE.-.-----------------------------------------ADDITIONAL COMMENTS - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- 1 ---------------------------------------------- ----- ------ ---------r --- --------------------------------------------- --- ------------------- ------ -- -- FinalInspection by: ----•------------------------ ----------------------------------------------------Date ----- � Z- SAN JOAQUIN LOCAL HEALTH DISTRICT' ;f E. H. 9 1-'68 Rev. 5M