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5 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------- --- ------------------ Permit No: _ ____ _ . ---------------- (Complete in Triplicate) This Permit Expires I Year From Date Issued Date Issued __ --- ---_=-�_3 ------------ ------ -- ------------- ---------------- Application is hereby made to the San Joaquin Local Health District for a per 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 77� _,_L�QiCs /1�.�-- '�'- .-- '---- 'ei�US TRACT --------------I-_----_---- Owner's Name -45;W145e l� .�e------ [.EJ'Q---------------------- -----------=----------- Phone ------------- ---------------- Address -----116-1-Fa-----f! t-S? Ls72- /--`& -------------- City _ A ------ Contractor's Name --_-- ,r_�f� License # aw2S iF"x.� Phone ---- --- Installation will serve: ResidenceKApartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:.--I------ Number of bedrooms ----_____Garbage Grinder _._____ ---- Lot Size ----1_46(•&-------------------- Water Supply: Public System and name ------------------------------------------------------ -------------------------------------------------------Private i Character of soil to a depth of 3 feet: Sand'❑ Silt fl ClayX Peat❑ Sandy Loam ❑ Clay Loam ❑ 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 p seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ j Size____________ ___ _ _ x_ _-_------------ Liquid Depth ------6-`-------------- 6 Capacity --1640---- Type - - Material-4-'--------- No. Compartments ---- ---.r--- Foundation -- _ _-__------- Prop. Line ------J7------- Distance to nearest: Well ---- AO_________________ � - ' LEACHING LINE [ No. of Lines .__' ______________ Length of each line.______7_ ----- - ---- Total Lengthhh_.. __Q_--------- tr 'D' Box _ _ Type Filter Material I�K*-----Depth Filter Material ----- Distance to nearest: Well _lQ !___-__.___ Foundation ----/0 Property Line ______________________ i SEEPAGE PIT [ Depth Diameter ---------------- Number ___________________________ Rock Filled Yes ❑ No .0 WaterTable Depth ------------------------------------------------Rock Size ------------------------------- O Distance to nearest: Well ----------------------------------------Foundation ------ Prop. Line -------------- ------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- r f � Septic Tank (Specify Requirements) ------------- ------ ----------------------------------------:------------------------------------- DisposalField (Specify Requirements) ------------------------------ --------------------------------------------- ---------------------------------------- --------------- --------------------------------------------------------------- -- ;4-0 --------------------------------------------------------------------------------------------------------------------------------------- ----------------------------l-------------------- ------------------------------------------------------------------------ (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 becom5A19bject to Workmen's Compe sation laws of California." Signed ----- --- ------a Owner BY ------------------------ Title (If other than owner) FOR DEPART Ry APPLICATION ACCEPTED BY ------------------ --------- -- ---------- ------ ------- DATE -- �_.lY - .3.--------------- --- --- - - - ' BUILDING PERMIT ISSUED ------------------------- ------- --- ---- --- ---------------DATE -------- ---------------------------------- ADDITIONALCOMMENTS ------------------------------------------ ---------------------------------------------------------•- ------ ---------------- -------------- i --------------------------------------------------------------------------- ------------------------------------- -------------------------------- ---------------------------------------=----------------- - - ------------------------ -------------------- ---------------- ' Final Inspection by: ._ Date -__-_-- --- ---------- ------ I SAN JOAQUIN LOCAL HEALTH RICT E. H. 9 1-'68 Rev. 5M