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FQR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- ------------------- (Complete in Triplicate) Permit No, ___ _-____ __ This Permit Expires'l 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 herlein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. JOB ADDRESS/LO ION .. ....7 -- --------- L�------ ----------------------------- --------------- -CENSUS TRACT 4 Owner's Name ! L ----Phone ----------- --j_--- -rte-------- ------------------ Cit _ 0 Q i^ ry Address -------------------- Y Contractor's Name "1----�_"�---------------.License Installation will serve: Residence•R;_AV-a-rtrrient House-E] Commercial:❑Trailer Court ;❑ f Motel ❑'Other -------------------------------------------- f Number of living units:__________ Number o eclt6bms -__Garbage Gr' der P.� Lot Size _ __-_�1_ � l Water Supply: Public System and name �-�.... ---_- -- ----------- ------•---------Private ❑ I ---- - ------------ -- Character of soil to a depth of 3 feet: Sand'❑� :Sil ❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ ( Adobe' Fill Material _}_ E4_ If yes,type ________________________-_ (Plot plan, showing size of lot, !kation of system in relatio% n to wells, buildings, etc. must be placed ion •reverse side. NEW INSTALLATION: (No septic tank or seepdge-pit permitted if public sewer is available within 200 PACKAGE TREATMENT [ l SEIiTltC TANK'[ ] : Size_________________ __ - G ----------•------------ Liquid Depth --------------------- � PaccY: -------------------- T _ -' ------ - --- Te Material_____._______ _ o. Compartments ------------ Y-13Distane to nearest: We11 -*----------------------------------Foundation ---- ---------------- Prop. Line ----------I ( - LEACHING LINE No. of Lmes - - Length of each line-.-------------------------- Total Length D' Box '----.-,_R Type Filter Material --------------------Depth Filter Material __ Distance to nearest: Well ________________________ Foundation �---------------------- SEEPAGE.PIT [ ] Depth _______________ Diameter ---------------- Number ------ - Rock Filled Yes ❑ No Water 4abie Depth --------------------------- ------------ -------Rock Size -------- ----------------------- Distance to. ------ 1Distancejto nearest: Well ----------------------------------------Foundation^-s--f------------ Prop. Line --------------------M°- REPAIR/ADDITION(Prev. Sanitat�hnlPermit 5 -------.---------------------------- - ----- -- Date ------------•---.__._-_-_'---;-�-_) i 1-1 Septic Tank Field (Sp Requirements) --- - ------------------G - ------�f� J --=- -- Disposal Field (Spcify Requirements) L �r 3 ' - --------------------- ----------------------------------- ------------------ ----------------------- • �, - ! W' #. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the cork 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 4ertifies.the following:., ° "I certify that in the performance of the work fort hich this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California:" t Signed --------------------------- - -- ------ Owner I + BY - ------------ ------------------------ (If -- - - ---- - - - (If other t o-�n�er}- ;t- t' ----------- -- Title ---------------------- FOR l DEPARTMENT USE ONLY �7— DATE -- Z�r 11 APPLICATION ACCE ED BY F _ `r BUILDING PERMIT ISSUED `- --------=-------°-- -------------------------------------------------------------------DATE ADDITIONAL COMMENTS ------- - -----' --- -- ---------------------------------------------------- -------------- -- { -------------------------- _ 1 _ , - -- ---- ---- _ } e Inspection b �_ ! P Y• - t-•_--,-`-'---•---- ----------------.Date ---�'��b�7/ ---'- Final fns ------•--'----I SAN JOAQUIN LOCAL HEAtT,H DISTRICT E. H. 9 1-'68 Rev. 5M