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FOR OFFICE USE: App�ICATION FOR SANITATION PERMIT 4 2?t, Ir . 03 Permit No: _7/7--4------------ ------------------------ (Complete in Triplicate) ------------------------------- -------- Date Issued This Permit Expires 1 Year From 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. 5449 and existing Rules and Regulations: " ,y - /)art vz-<-_ CENSUS TRACT _ JOB ADDRESS/LOCATION .------�--� ---- ----- - - i /r. -----Phone Owner's Name --------- � r-------------'�=`�.'-'t------ Cit ------- Address -- --- -�-y-- ----y�-��i./>�'-=----- - ------ ---------------- -- Y ---, ------------------ Contractor's Name = `-�'=`-------------------------------------------- Installation ------------------- ---- - -- -------- ---.License* ------------------------ Phone ----------• --------_------- Installation will serve: Residence,9 Apartment House-❑ Commercial][]Trailer Court ❑ MotelE]Other -------------------------------------------- ---•-- Number of living units:.-_-f ---- Number of bedrooms _�--------Garbage Grinder _---_----_-_ Lot Size ----------- Water Supply: Public System and name ----- ------------------------------------------ ---------- -------- ---------------------Private„] Character of soil to a depth of 3 feet. Sand ❑ Silt❑ Clay ❑ Peat F] Sandy Loam � ClayLoam'A3 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 seepage pit permitted if public sewer is available within 200 feet,) i SEPTIC TANK, Size--vk -1 D-- C---- --------- Liquid .Depth --y-- v--- ------ PACKAGE TREATMENT [ ] [� N. Capacity �_ _ ------ Type �" �� Material --------- No. Compartments -y-----=---------- Distance to nearest: Well ------ ----------------------- Foundation ------0- r Prop. Line ---` ----_ LEACHING LINE �[�j No. of Line --.Z-_------------- Length of each line_-_A_` ---------------- Total Lengt 1 �, D' Box «�--- Type Filter Material -�ti---------Depth Filter Material .-.�_9 -____-___•----------------•-__-.. Distance to nearest: Well --SCJ ---------- Foundafiion - --------------- Property Line -- f .------•-------- SEEPAGE PIT [, Depth _2_r� ------ Diameter --------- Number ------ ,.` --- --------- Rock t=illed Yes No I❑ { Water Table Depth --- r------------------------------------Rock Size -I ------------------ Distance to nearest: Well -At-7--------- ----------•- -----Foundation --/ ----------- Prop. Line ..tisL.------•- --- REPAIR/ADDITION(Prev. Sanitation Permit ------------------- Da#e . ----------•----- =# Septic Tank (Specify Requirements) -------------------- -----------------------------`--------_ -- Disposal Field (Specify Requirements) --------------•- -- --- ----------- --------- ------------ ------------ --------------------------------- I ------------------------------------------- ---------------------------------------------- ------------------------------------------ ------------------ (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: ` ( For which this permit is issued, I shale) not employ any person in such manner "I certify that in the performance of the work as to beco object to orkman's Compensation laws of California." ,e Owner Signed ---- ---- -- 60�_ ---- ---------- Title ---------------------- - ------------- ------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY > ?�..��71---------------- -------- --------- - ---------- ------ DATE --- ---- -- APPLICATION ACCEPTED BY ---w�- - DATE ------ ---------------•---- BUILDING PERMIT ISSUED - ------ ----- ------------------- - - - -------- ---- - J n ��/------ - ----------- ADDITIONAL COMMENTS ------ `- ---- /�ir'�' ----- + - ---------- ----•- -- ---------- ------------ --;�V ------------- ---- --- -=--- ---- - -- ----- - ------- -- - - Date F - -- - - ------ Final Inspection by: --- -:=-2P�-- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M