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FOR OFFICE USE: -__ rn APPLICATION FOR SANITATION PERMIT I�1 -------- -------- ------------ry / �3 (Complete in Triplicate) Permit No. __�-_-_-----_____-. �� :_-_____ 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 _,� __ _,____- '___�� --�C �---Nd =�C -CENSUS TRACT -------------__----------- Owner's Name . - ------ --------- ------ --Phone ------------------------------------ ` _� /yam Address ' ' J -----.... City ./,-_ ? Contractor's Name ___ xG.•- _ ,__ __ _______ --------------------------License __ -__1Phone Installation will serve: ResidenceXApartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ------------------------------------------ Number of living units:----7---- Number of b drooms -__Garbage Grinder l✓__Q----- Lot Size -- - ,X a: -- ,. Water Supply: Public System and name -_ c�_____ __________.-_ _-eQ_.-___- --------------------- ------------------Private [ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 'k 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,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] ,c�,r�S7_l 96zd ---------------------------------------------- Liquid Depth -------------------------- Capacity -_____-_-____._____Capacity -------------------- Type -------------------- Material---------- ---------- No. Compartments ---------............. Distance to nearest: Well ___________-_____-_______________Foundation ---------------------- Prop. Line ...................... 7V f _ Total Length LEACHING LINE No. of Lines ____- ___________ Length of each line________�D____-___ __ g ___� '!.________.._ 'D' Box -_-_f----- Type Filter Material ----ed Filter Material --- _________________________________ Distance to nearest: Well ----0S_C----------- Foundation _ZC_1-_________ Property Line -_`S7.. ........... SEEPAGE PIT rVe Depth c_�S_------------ Diameter __f_` Number _______ _____________ Rock Filled Yes No 0 Water Table Depth ------- ---------------------------------------Rock Size _____ ---------------------- DistaDistance nce to nearest: Well ---- / d__ __•_______,_..-Foundation ___ --- ---___ Prop. Line ..... ------ ------- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) -------- ------------------------------------------------------------------------- ----------------------•----,.-------------------•------- Disposal Field (Specify Requirements) -__ -_______4�_ ------- _ ------- --------- QzV ✓�'�- ---- ---------------------—----------- 9-------- -------- �! ---------7 ----------- ----------; `A----------- -------------. '�rfC1� `'•. _ <� e-/.1 -------� ------- -1�7e/ `r z--------- (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 become subject to Workman's Compensation laws of California." Signed ----------------- ------------------------------------ ----- Owner .BY ------------ _��=---------------------- Tte ---------�+ " -- (If other than owner) FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY { 4-4----9- -- - - ---------------------------------------------------- DATE ----L � --------- BUILDING PERMIT ISSUED ------ -------------- -------DATE ------------- ----------------------------- ADDITIONALCOMMENTS ------ ------------------------------------------------------------------------------------------------------------------------- ---------- ----------------- ----------------------------- - --- -------------- ------------------------------------------------------------------------- - - --- - --- - 1'] -----------`-�0'---� ---- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- Final ------- ---------------------------------- _ _. -------------------------------------------------------------------------------------------------- -- Final Inspection by: `y'- ' Date ----- ------ ------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M