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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . !E (Complete in Triplicate) - ---------- --------- ------ -------------- Date Issued This Permit Expires 1 Year From Date issued 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: - v - -i----- ------- ------ ---------- ------ --------- --- ----.CENSUS TRACT ------------------------- JOB .ADDRESS/LOCATION ./5`7.__.- _-Z.__- . Owner's Name - l ! -- one . .. R Ltn I ..� l City Address ��7 �/f� ------------------------------------------ - --------------- Contractor's Names+ r -------License # � .3hone Installation will serve: 1`Residence Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other ------------ ------------------------------- Number of living units:--.---- Number of bedrooms --..Garbage- Grinder ------ Lot Size __ --------- Water Supply: Public System and name --------- -----------------------•---------------- --------------- --------------- ----------Private Eh Character of soil to a depth of 3 feet: Sand'❑ Silt F] Clay El Peat F] Sandy Loam Ciay Loom .[:] Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ----..____---------------- {Pl'ot 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:[ ] ' `` 'ti Size-------------------------------14 --------- _ Liquid Depth ...-----.-_---------:----- J. P fi' D - - e - TYP - ------------- Material------------------ --- No. Compartments ------•- stanceto nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------.------ { LEACHING LINELines � No. of -_-- - _. -, Length of each line____________________________ Total Length ----- �[ ] 'D' BoxI.-------I--- Type Filter`Material --------------------Depth Filter Material -------------------.-------------------- * II .-___. Foundation -------------------_--- Property Line � Distance to nearest:Well._------------------ ------------------------ ' ► , yr_ ; ------PIT ------------------ ❑ ?❑ it Water Table Depth ------------------------------------------------Rock Size ---------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ..---------------._-.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------11 I Septic Tank {Specify Requirements) ---------------- ---------- ------------------- -• ------------------ -!----------------------------- Disposal --------------- --- -------Dis osal Fieldy(Specify Requirements) _ ----- ------------------------ - -------;--------- ------ --------------------------------- -- ---- ---- -------------- ------ 1 I hereby certi that 1 have r I a -- existing quire- ------------------------------------------- ------- -------------------------------- -- ----------------------- {Draw existing and required addition on reverse side} y fy 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 liven- 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 r as to be omLsubbiect toWorkman' s Compensation laws of California." Si ned Owner .----- g By ------- - ---- (If other than own ------------------------- Title - ----------- ---------------- -`er) II FOR DEPARTMENT USE ONLY e E APPLICATION'ACCEPTED BY ----------- ----------------• DATE - ----/ - BUILDING PERMIT ISSUED .----- '- - --------------- ------------------- DATE ADDITIONAL •COMMENTS --- ----''- ------------------------------ --------------•--- - - �- ----------------------------------------- ------------------ -..-------------- Final Inspection -- ----- ---- - ----- ----------------------------------------- py -----------------------------------------------------------Date`? . -. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M '�