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FOR FFICE USE: APPLICATION FOR SANITATION PERMIT _ ----------------- - '�I� --------- ------ - Permit No. (Complete in Triplicate) =�� ��'--------------------------- ,.. Date Issued -- ---:Z_`:----r -��____ This Permit Expires 1 Year From Date Issued i 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 AbD.RESS/LOCATION ;__70-LTJ-�__.-- -------- - - -- -- --- - -- ------.CENSUS TRACT -------------------------- ' Owner's Name --- -- ----Phonez�/-'--34-�7----- ------ -------------- ------- Address -_ � ----- -- City - 7 Contractor's Name ------------------ - ---�--- ------ ------.License # (.- f/ Phone _ y-� �� J� lnstallafiilon will serve: ResidenceApartment House Commercial ❑Trailet Court ',❑ J' Motel ❑ other ---�------------------------------------- Number'.of living units:------!-_--- Number of bedrooms _ -,__..Garbage Grinder ------------ Lot Size -------------------------------------------- Water -_"____"-_.____"__ - Water Supply: Public System and name _______________ -------------------------------------------------------------_ _ _ Private �- s 'a Character.of soil to_a depth of 3 feet:,�$grycl Silt❑.,=_Clay, .❑�„Peat_❑ Sandy Loam-.❑ :.. : i Hardpan ❑ Adobe ❑ Fill Material _____ If.,yes, type -- --. F-- ------------- -- �._ __ (Plot plan, showing size of'[ot,,-location oflsystem in relation to wells,"buildings, etc. must be placed onreverseside.) NEW INSTALLATION: {No septic tank or seepdg� pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTICATANK f-11 Size--------------------------- ---- Liquid Depth -------.--------•----• Ca acit` ] f Type -------------------- Material---------l------------ No. Compartments ------------------------ Distance to: nearest: Well ----Foundation`- - -----Foundation ------ --------------- Prop._Line`�------------ t e r ' Vt 1 LEACHING LINE [ ]� .No.iof 1ihes ----i- Length of each line---------'------------ ------ Total Length ,------•-----------.....---- _De the Filter Material -------------------- -. ' D' Box Type Filter; Material p --------- - --- --- I Distance.to^nearest: Veil --------------------- Foundation -- --------------------- Property Line. -------------------••-• SEEPAGE PIT [ ,� Depth - ------------- Diameter—_=____—�- ~Number------ --------------------- RockFilled Yes ❑ No d ll Water Table; Depth.------------------------- ------------Rock Size __.----------------------------- I Distance to nearest: Well -----------------------------•----------Foundation --------------------- Prop. Line ---------------•------ REPAIR/, DDITION(Prev. Sanitation Permit;P ---------------------:------------------- Date --------------•-------------•-----1 t i Septic Tank (Specify Req�iirerr ents) -------- -- - ----- -- ----------� - = :- Dispol al Field (Specify Requirements) .-------- - - -------------V_,_0------------ ---- ---- g ---------- --------------- - ---•--- --- --�---------- ---------- ------------------------- ___.__ ____ _ _ _____. ---- _ I f (Draw existing and required addition on reverse side), �t .! \� ,S I hereby certify that I have-prepared this application and that the work will be done-ken accordance with San Joaquin County Ordinances, State Laws;�pnd,;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, 1 shall not employ any person in such manner as to become subject to Workman's'Compensation laws of California." 1 i r � Signed -li--- --- - =-----------------•----------- Owner I - ------ - - ----- ------- --------- ------- ------- Title ' -------- '----------- By -------I-- . ------ -------------- (1f other t owner) FOR,DEPARTMENT USE ONLY BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE l� �6I ------------------------ DATE APPLICATION ACCEPTED BY --------- -------- ” ! - ----- ADDITIONALCOMMENTS -------------------------------------------------- ----------------------------- -----------i---- ------------` ------------=- ------------ �--- ------------------- f_ il -- _gT _ ._ _. it _ - Date',-- --------------- ------------- ------------ ------- 1 Final Inspection by = `"'� . ---------- ------- -- --- = SAN JOAQUIN-10CAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M 1