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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- (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: /-rcv 1"2-if JOB ADDRESS/LOC) .4._�/____ C,SQe% lu� _� �` -__da-CENSl15 TRACT -------------------------- Owner's Name ./___/ Ply � $�iC3 ------- ------ -------- Phone ` - Z Address ( ra r -� d-- -- ------- �� City _l� /'I�_T_ - �y n Contractor's Name __. f-_,_. License #a - _ -� Phone ,2-3....--.._...AF. t Installation will serve: Residence Apartment House^❑ Commercial *'frailer Court ;❑ Motel ❑Other ------------------------------------------ Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size .�� _ Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: SandSilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-E] 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.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (� PACKAGE TREATMENT [ ] SEPTIC/__ '[ ] Size__ ___ ___._________________ Liquid Depth -------------------------- Capacity _--------______ ___,Capacity ---- ------ Type -------------- ----- Material-------- ---- No. Compartments ------------._......... Distance tost: Well _________ _______-Foundation _ � Prop. Line LEACHING LINE [ ] No. of Line _______________ ngth of each line---------------------------- Total Length ----------- .............. 'D' Box _____ ype Filt Material ____________________Depth Filter Material ________________________________------.._-__ Distance to t: W I ____________________ Foundation __.____._____________ Property Line ________________________SEEPAGE PIT [ ] Depth ______. Diameter ________________ Number _________________.___._____ Rock Filled Yes ❑ No 0 WaterTable ------------------------------------------------hock Size -------------------------------- Distance to : Well ----------------------------------------Foundation -------------------- Prop. Line ............. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) � Septic Tank (Specify Requirements) ------- / _ ------L-------------------------------------------- ------ -- -- --- - _ Disposal Field (Specify Requirements) _ _ '_L ___ �I_� - ______ ___ ______ /s5 r - --__-_ -------------------- ------------- -------------------------------------------- ------------------------------------------------w---------------------------------------------------------------------------.---------------- (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 orkman' Compensation laws of California." Signed -------- ---------- - ------------------ ----------------------- Owner BY ------ - --- --------- Title ---------------------- ---- ---- - -------- --- ----- - ------------------------------------ ------- (If other t an owner) FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY --------------------------------------------------------- --------------- DATE ----- l- —/0----------- BUILDING PERMIT ISSUED ----------- ----------------------------------------------------- ----- ---------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS --------------------------------------------------------------------- ----------------------------- - -------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- ------__ _ ___ - - - - ------------- _ Final Inspection by: -- - --------- - Date �Y jr� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M