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.. I FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------- _ (Complete in Triplicate) Permit No: 6—V--___ --------------------------------------------------------- This permit Expires ] 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 compl'ance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION5� -- '-_s:Z " ---___i----- CENSUS TRACT _--$ 11?_-...----_-- �,/ GZ•iryl2ls Owner's Name ----- 7 -------------------------- ------------- -------Phone -------------- •---- 1 Address --- ----------------- C�tY Contractor's Name _ " --- - ---------------License #oZ-v Yl�----- Phone VAI6' . ll Installation will serve: Residence [Kpartment House❑ Commercial :❑Trailer Court i❑ t Motel ❑ Other -----------------=-------------------------- Number of living units Number Number of bedrooms ___)___Garbage Grinder ------------ Lot Size -------------- ---------- Water Supply: Public System and name __ __________________s_______Private E] i Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material_____________ If yes,type ---------------------------- 41 i (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 -------------------- Mater'ial---------------------- No. Compartments ------•--------------_ Distance to nearest: Well __________________________:__=____Foundation ---------------------- Prop. Line -------- ------ i ` ! i LEACHING LINE [ ] No, of Lines. ---------- Length of each line____________________________ Tata! Length __________._____....-....__ 'D' Box ------------ Type Filter Material --------------- Depth—Filter Material ----------_---------.-----------_...•..__-- # Distance to nearest: Well ________________________ Foundation ------------------------ Property Line- -----------------.-_--__ SEEPAGE PIT [ ] Depth Diameter _______________ Number ----- ----- Rock Filled Yes ❑ No Water Table Depth ----------------------------------------=-------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -_.----------------- Prop. Line ----------- ....... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- ----------------- Date -------.--------------------------I Septic Tank (Specify Requirements) --------- t-- --- Disposal Field (Specify Requirements) ___� .r �f____o2 _I � _--------- c, 1 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 �f 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 . of employ any person in such manner- f -- f as to be me subjec,to Wor man's Compensation. laws of:California.'.",' Signe -------------------- Owner By ---- --- - -- ------ -------------------------------------------------------- Title ------- ( ------. ------ -; _ (if other t� owner) _ -�~ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 0 ------------------------------------------- -----------. DATE ----l ---------------------- BUILDING PERMIT ISSUED ----- - ------------------------------------------ --------------- DATE ----------------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------------------------------------- - --------- _6� --- -------------------------- -- ------ - Final Inspection by: ____ _ _.___ ____ __Date t�'_.---------------------------------- C, SAN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M, 4