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FOR OFFICE USE: . APPLICATION..FOR SANITATION PERMIT q ---------------------- ----------------1� Permit No. (Complete in Triplicate) ` ______________________________ This Permit Expires 1 Year From Date Issued Date Issued ___7T�FV 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 compli nce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATTIIO'N --�Q��.-- )----- / ---------� � ---CENSUS TRACT Owner's Name C. ' -ems......... C ----------------------------------------------- ----- -------- ------Phone ------ s--------- -- --------- Address .... .-----y---------------------------- City �J C .�c1---------�t --------- Contractor's Name ',r_ ,.cLicense #�S'-V XZ?Phone Installation will serve: R id, ce partment House❑ Commercial ❑Trailer Court i]] Motel F-1 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: Sand❑ Silt❑ Clakcrt,eri Peat E] Sandy Loam .0 Clay Loam ❑ Hardpan E] Adobe❑ al ------------ 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 ( ] Size________________________________________ Liquid Depth __-_______________________ Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------ ---------.:.._. 0 1 Distance to nearest: Well ---------------------------_------Foundation ---------------------- Prop. Line ___-________-:_-___-_. LEACHING LINE [ ] No, of Lines -------/------------- Length of egch line---------.;V------ Total Length _____ C .............. <5r,q 'D' Box __ Type Filter Material _,€ %5� _ Depth Filter Material Distance to nearest: Well ___ l»___ _____ Foundation ------------ Property Line -- ��.�---__-_____ -- - --_ Diameter _____ Number ___ -- SEEPAGE PIT [ ] Depth ___ ___. - /----------------r Rock Filled Yes � 9' Water Table Depth _____ --_P______________________ ______Rock Size _er �j Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line -__-_--____--_--___--_ REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------•----------------------------------------------------------------------- /----'----------- ------------ Do I Field (Specify Requirements) :__ , __r_ ____ ___ _ ---------- is. - - � �' ..�-r_____ ------ - --- ---- - --- -- - - .......... ---- ----- - -- ------- - ------------------------------------------------------------------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to becom s ct to Wo maws omp tion laws of California." Signed ------------ -- Owner By ----- ------- ----------------- ----- Title ...... ---� (If other than owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ------------------ -•-------------- -- --- ------------------ DATE ------- BUILDINGPERMIT ISSUED -------------------- ------------------------------------- ----------- --------=--------------DATE ------- ---------------------- ---------- ADDITIONALCOMMENTS ------ --- - -- - ---------------------------------------------------------------------------------------------- ---------- ----- --------------- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ - --------------------------------------------------------------------------------------------------------------------- ----------------- ------------- --- ----- ------------------------- - ---- ------ ---- -- ------- -------------- - Final Inspection by: ----- ---- - --------------------------------------------------------------------.Date ----- SAN JOAQUlN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �L-01