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FOR OFFICE USE: • APPLICATION FOR SANITATION PERMIT Z-- 3 f . --- ----- ------------------------= Permit No (complete in Triplicate) ---------- ---------=----------------------------------------------- -------------------------------- --------__-------------- 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 iiss�maajdejin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ."/ Col____ --------------------CENSUS TRACT __-:�-�_�_____ Owner's Name ` �--- --------------Phones�_3.`'/�Ct.� Address d_ ._ __f'_`�/i� _. VZ----------------- ------------ Cit �i� _7 ------------------------------------------- Y ry,� Contractor's Name -- /9 License 4-�. 0-- Phone��--- Installation will serve. Residence [Apartment House❑ Commercial:❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number of living units:.-l------ Number of bedrooms J______Garbage Grinder --— Lot Size __ Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'eSilt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ----------- If yes, type -------------------------- (Plot plan, showing size.of lot, locatign .of system in relation to welit, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: ``` �' ~ (No septic tank or seep a it permitted pug is se is availpb�f within X00 feet,``) ,� O PACKAGE TREATMENT { ] SEPTIC TANK'[ Size_f___-�___ 7 _ ---�_-_______ Liquid Depth _/q?_______________ Capaci ------- Type e_1A_4?__ Material<NMl6�9—r No. Compartments ;;:;?�---------_•--- gy, Distance to nearest: Well �Q f 1 -------------------------Foundation - -- --------------- Prop. Line =aC�0....... LEACHING LINE (L}-o' No, of Lines __J---------------- Length of each line___-- --------------- Total Length ........ 00 D' Box f- 's__ Type Filter Material � ______Depth Filter Material /?____________________________________ D Distance to nearest: Well _ 3Qo_---___ - Foundation ,2-Y----- Property Line SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size --------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------------.----. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ------------------- --------------------------------------------------------------•---------------------------------------------------•---- Disposal Field (Specify Requirements) ---------- --------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---- Owner SY -------------- -- -�--------`- -------------------- Title _04�,o1ez -------------------- (If o er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.-7Fc_R_,_0_ ._ DATE ____6 _' BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE -------------•----------------------------- ADDITIONAL COMMENTS -- --- ------------------------=---- ----------- --------------- ------ -- -- ----------------- I --- - "' r f ---------- -- - v ----- ----- - --- --- ------- ----- -------- •-- Final Inspection by: Date ----- _-- _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M