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FOR OFFICEv SE: i t - . . _APPLICATION FOR SANITATION PERMIT . .w... Permc it No. � ." " (Complete in Triplicate) ---------- ------ " -'] Date Issued _ _______________a _______._ __(,t'-�___ ______� ar "' 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 aCnty Ordinance No. 54 and a st Rules and Regulations: JOB ADDRESS/LOC N - 3r T~ _r ._ -- ------ - -_. .___�WPIRACT -------------------------- ;J Owner's Named �-5 ------ ----- -Phone ------------------------------------ Address ------ - -- ----- city �- ----------------------------------•------ Contractor's Name -------Ate--/•60--- ---------------------------------License #` - PhoneG'3 Installation will serve: -Residence;16Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of livingunits:.___,--- Number of bedrooms ____ /�� Lot Size __ _ �---Garbage Grinder --------- - .� lG'a�/`-� ------------------ WaterSupply: Public System and name ------------------------------------------------------------------------------------------------------ -•-- .Private Character of soil to a depth of 3 feet. Sand Silt E] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam D 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 [ I SEPTIC TANK' Size_ _ __ ~__!__�_`_______ Liquid Depth —_— ------------ Capacity _____ -__-Capacity zAaw--- Type�� -_ ___-___-- Material9p,/ �r h_ No. Compartments ---�-............. ori, Distance to nearest: Well ___ �_�___________________Foundation _ �_r ,�"�_�__._ __ V ___.Prop. Line __ LEACHING LINE No. of Lines ---------"-""-- Length of e�ch line -- -- ---------------- Total Length -.- ------------------ �� 'D' Box (, ._ Type Filter Material *eDepth Filter Material _��_______________________________ Distance to nearest: Well --_e E.________ Foundation ./�_�_-_---__--- Property Line __!°o-_^__-__.__ 'I SEEPAGE PIT . [ ] Depth ----?--I---------- Diameter 4 _IF___ Number -----`F_________`--_____ Rock Filled YesV No i❑ Water Table Depth .......2-_�,---------------------------------Rock Size/'--- - r------------ Distance to nearest: Well ____ _ ___________________Foundation _ ./_.____ Prop. Line ___e"+s REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------`------------- Date ---------------------------------_) Septic Tank (Specify Requirements) _ C/ Disposal Field (Specify Requirements)----------- - = -------- --------------------------------------- ----------------- -------- ------------------------------------------------ ----- --------- ------------------------------------------------------ - ------------------- ------------------------------------------------------------------------------- (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 as to become subject to Workman's Compensation laws of California." Signed -- ------------- g - - ----- - Owner h BY ----------------------- -- - Title - ----- -- ----- --- ------ - +' ------------------------------------- (If er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -__ _-_____ --------------------------------------------- - -- - -------------------------- DATE -A ------------------- BUILDING PERMIT ISSUED ------------------------------------------------------------ - --------------DATE ------------------------------------------- ----------------------------- -- ADDITIONALCOMMENTS ----------=----- ---------------------------------------------------------------------------------------------------------------=--------------------------- ------------------------------------ --- - ---- - -- -------------------------------------- ------------------------------------------------------------------------------------------ - --------------------------------- - --- --- -- -- ------------------------------------------------------------------------------------------- - r ''::n==::=: Final Inspection by::: ------------------------ ----------- Date ------- ------ -------- ------------ ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.