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y � ; FOR OFFICE USE:, APPLICATION FOR SANITATION PERMIT ---------- ----- 40------------------- ti .�� (Complete in Triplicate) Permit No. - ---------=---------- ------- `t___<.----- . Date Issued } t This Permit Expires 1 Year From Date issued -------------- Application Application is hereby made tb the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application isVmade incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N ------ _ - ------ ' ----- - ------------------ - ------------------------------- ----CENSUS TRACT -------------- ----------- , - ------Phone'V7*-=7-feZ4[---.--... Owner's Name ,,_- ` 7 Address ------------- ---•----•-- City ----- ----------- ----••----- - •----••------ 1 - f SOS --- License # Contractor's Name ___-- / Gf--- Phone --- --------•• - - ----- ---- ----- - ----- -----1' Installation will serve: Residence�.Apartment House❑ Commercial ❑Trailer Court i Motel ❑Other\-------------------------------------------- 1 _--------------------•--------- ---- ---- r Number of living units------------- Number of bedrooms --_____.Garbage Grinder ------------ Lot Size - -_______-- ---.____ t ____Private ) Water Supply: Public System`dncl .name -------------------------- --------------------------------------- - ------ Character of soil to a depth of Pet Sand❑ Silt fl Clay E] Peat E] Sandy Loam ❑ Clay-Loam ❑ Hardpan ❑ Adobe` Fill Material ------------ If yes, type --------- -------- (Plot plan, showing size',<=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,) -.L i i PACKAGE TREATMENT [ ] SEPTIC TANK.. f] Size-____ -- - ------------- ------------ Liquid Depth -S -- ' f ti Capactyt' vt7 [- Type - T_____ Material- Cd/tJC'------ No. Compartments _---y-.-. Distance to nearest: Well,_, 5_Q-------------------\-Foundation ------------ Prop. Line ---__-ter_-.. --__----- - a - LEACHING LINE '4fa No. of Lines -"""--- - - - -- �+ - - ------ Total Length Q-------------•- �L'""'�---� Length�'af-each line---_----- --- - - g f _a , D' Bob- -_ --- Type Filter Mate 14 Filter Material _-.f------------- . ri Foundation .---f - ---------- Property Line • Distanceito nearest: Well - I ----. l t SEEPAGE PIT l if , Depth ..-- -------- Diameter U---_.---- Number _.---- ------------- Rock Filled Yes No I❑ VV ! ------------ ---= ------�--------Rock Size- ----�1- - ------------------- Water Table Depth N I Od f ` Fouridation,__.f_ -r ,---- Prop. Line Distance to nearest: Well ------ r----- ------------------ I--s { REPAIR/ADDITIO 4(Prev. Sanitation Permit�# -------------------------------------------- Date ==-.___ ------------------ I - -- 1 i 1 ; ter Septic Tank (Specify Requirements) !------------------------------------------------------- --- ----= --{ { .r Y, e ',Disposal Field {Specify Requirements) -._"--- --------' � --==-------------------�--------------------------------------------- I -----------------i------------------------------ ----- ------------------------------------------------------------ (Draw existing.prid 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." I Signed __ -_- �__._.-- .---- - -------- =------------ ------------ -- -- --- r r$ Title - ByC ----- -------r (If o e than owner) FOR DEPARTMENT USE ONLY I r / APPLICATION ACCEPTED BY DATE /__�--� '� - -------- - -- BUILDING PERMIT ISSUED ------------------------------ - -------------DATE ------------------------------------------- ------------- -------- _ ADDITIO L I COMMENTS ----------- _Ff - --------- ---------- - -----------------------" _ ----__-_-- ----•----- - - [ Final Inspection by: Date ___-. -- --------------------------------------- SAN JO QUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M