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FOR OFFICE USE: ,: ti APPLICATION FOR SANITATION PERMIT ---------------------- (Complete in Triplicate) Permit No. ---------- ---- ---------------------------------- Q r� f U ______________ This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATION - �- --G ---�-- ---------- ----CENSUS TRACT -------- --- - - Owner's Name ------ Lls- ------ ----------------------------- -------Phone Address -----------satr�-S�. ------------- City ` Contractor's Name ---- ---- --------------------- ----------License #/0?4W------ Phone Installation will serve: Residence [Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑ Other -------------- ---------------------------- Number of living units:----- ----- Number of bedrooms _Z------ Grinder -H-10.... Lot Size ..... Water Supply: Public System and name ---------------------- ----------- ---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam El Hardpan ❑ Adobe-' ill 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,) r/ l PACKAGE TREATMENT [ ] SEPTIC TANK} Size_ vL:�''______---------------------- Liquid Depth ___ --- ________ /r�-.9� p y yp Co acit e kt—:6___ Material--- � No. Compartments ___~ ----------- -__fLDistance to nearest. Well ________0______-_ Foundation _467--------- Prop. Line ------- LEACHING EACHING LINE _01�_ No. of Lines ---I------------------- Length of each fine...1_0Q---------------- Total Length ,____-Imo__`_________. 'D' Box ----- ----- Type Filter Material►sf4-4____Depth Filter Material ____f_ '"____.________________•...... Distance to nearest:-Well 7zP._f------------ Foundation ..-I--2P ------- Property Line. ___ --___-- __ SEEPAGE PIT Depth _ '� �3_"___ Number ._��'r"L_A.-2,__ Rock Filled Yes,L No ________ /Diameter I❑ Water Table Depth -60-_� ___Rock Size ___r_.__---______ ------------------------------ - ------------- f a _Foundation f' p Pro line Distance to nearest: Well -----�--dr--r- ------------- ----- -- -�----------- -- -------------- P• -�--•-- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------- --------- Date ---------------.------------------) Septic Tank (Specify Requirements) --------------------- -- - --------------------------------------- ---------------------------•-•---------------------------- - - -------------- 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: "1 certify that i he performance of the work for which this permit is issued, I shall not employ any person in such manner as to become b ct to W rkman's mpens ti laws California." Signed --- *� ----------I ----f------------------- iffier By ---- -------------------------- - - ----------. Title --- ,Q. . --- -- ..-- --- --- --------------- ------------ (If - ------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __e,_ :____-_.-_ __ DATEQ_-._--Z------ 0-____-__-___-____ BUILDING PERMIT ISSUED -------------------- -- - DATE -------------.-----------------------.----- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------- ------=-------- ------------------ ---------------------- ---------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------- ---------- ---------- ------------------------------------------------------------------------------------------------------ ------------ ------- ---- - - ------- ----- - t Final Inspection by: -----------°-- ---r- ---------------- Date 1----------- - ------ ----------- ---- --- --- - - - - ---------------------- S UIN LOCAL HEALTH. DISTRICT E. H. 9 1-'68 Rev. 5M