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FOR OFFICE USE: APPLICATION„FOR SANITATION PERMIT _ - ------- -=------- Qe' ------==- Permit No: r (Complete in Triplicate) , --- = =' _-------------------------------------------- This Permit Expires 1 Year From Date Issued Date issued _Z-_-------__-?_Z i �- # 3 A # Application is hereby made to the San Joaquin Local Health District for ci 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 -�- --- 5�-r�__ __._ CENSUS TRACT _______=_-______ _--__---t ft Owner's Name -------- ---------------------- ----------------------------- ----- ------------ --------Phone -------------- ---------------------- I Address ------------------- --- e_4 �---- -------------- -----------.;City -----� - ----------------------------- ----------- Contractor's Name --- ------- 5l4s4_- ------------------------------- ------- -License # -1 .3 ---- Phone - '--------------------- Installation - Z--------Installation will serve Residence P-Kp'artment House❑ Commercial ❑Trailer Court i❑ 1 ' 3 Motel ❑ Other ----------------------- Number of living un ts:__.-___r---- Number of b ooms -------Garbage Grinder ] -_ Lot Size _7.�}�/,�_____________________ f �� Private ❑ Water Supply: Public System and name ________ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe• Fill Material /VP--- If yes,type __________________________i_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on 'reverse side.) NEW INSTALLATION: I {No septic tank or seepage pit permitted if public,sewer is available within ZOd feet,) PACKAGE TREATMENT [?`] SEPTIC TANK [; Size-_-- _ __, _ __________________ Liquid Depth __y -7-__________,____ U € /` Z W Capacity ---14 Y __.--_ Type - Material C_f k6—�, . _6t� ________No. Compartments ___________ W Distance to nearest: Well _--_______`-`-_~______________p_-Foundation _____ �______ Prap. Line!_ _�______._ :_. O► LEACHING LINE [ ]' No. of Lines -----Q---- g �__ ____ Total Length "____ --------------- I ___ y --____-- Length of each line.--- - -�-- ----------------- _ 'D' Box feA------ Type Filter Material Q+ [1_k" Depth Filter Material ------ ------------------ ` ! Distance to nearest: Well ___ - ------------- Foundation _____________ Property Line -- ___.___.__._.___ SEEPAGE PIT [X i Depth ------- Diameter Number ______ -------------- Rock Filled Yes' ]K No C] ` Water Table Depth --------6-9- -------------------I---------Rock Size K t I Distance to nearest: Well ----------- ___________________________Foundation l� ___i____ Prop. Line ____.___._ REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----__------------.-•-'---------I ` Septic Tank (Specify Requirements) _____ - .. r'' -- ----------------------------------------------- DisposalField (Specify Requirements) ---------------•• --------------------------------------------------------------- ---------- ---------------------------------------- t --------------------------------------------------- ------------------------ I i,�� . (Draw existing and required addition on reverse side) I hereby certify that I have preparedithis 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 per`formaiice of the work for which this permit is issued, t shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." , Signed ----------------- " 1 --------- -- -------------------------- ------ Owner i By rl � ---------------- Title ------------ ��--�'-`-=� ---------------------------i [If other than ow eDEPARTMENT USE ONLY APPLICATION ACCEPTED BY - / = = ---_---`---------- - i DATE z -?v ------------------ - BUILDING PERMIT ISSUED ------- - -� -- - .---- - ------- --------------------�----•-----------------------: ------DATE -------/-------------------------------1-•. -.--- ADDITI VAL CO -------- - --=-- =7" ---- -- �/ - -------------------- ------ -- - -------------- -- -�--- ¢� _ Final Inspection by: -------- - -----------------------_- -------------------------------- � -------- -- ---- -- - .Date --------- '� " ---�----- -- S JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M f