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FOR OFFICE USE: 033 � M. ' 70 ` APPLICATION, FOR SANITATION PERMIT 3 0 ----------- �. --[ �'�...3 Permit No. ------ -- - _ / (Complete in Triplicate) ------------------------------------------i--------------- 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: .JOB ADDRESS/LOCA / �f ------ -- - ----- --CENSUS TRACT ------7 --------- Owner's Name -/,,,----- ----------------------------------- --------------------------------- ------- ------ --- - ------ --- Phone l Address -- : - y6 ------. City - -- - �� - - - Contractor's Name ------ ------:--------=--------License # ._ i�hone it Installation will serve... Residence partment House,[] Commerciale❑Trailer Court :E-]Mot I ❑ Other = / Number of living units:________ ___ Number of bedrooms ---- -_ ___Garbage Grinder Lot Size 1 � ; Water Supply: Public System and name ---------------------- s -'- 'I.=--------- - --------------------Private ------------ f- - Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑'- Peat❑ Sandy Loam ❑ Clay Loam i Hardpan ❑ AdobeA, Fill Material ............ If yes, type ---------------------------- (Plot plan, showing}sie of lot, location of system in relation to wells;�buildings, etc. must be placed on reverse side.) u .,- ( septic seepage p p sewer is available within 200 feet,) Ilk PACKAGE TREATMENT.' SEPTIC TANK' "" ze____ _ _ Liquid Depth _ -.-___-_- NEW INSTALLATION: {No se tic tank or see a e et ermitted if public Capacifiy -- - -- ---- ---- Type PIO_tt,Material_ o. Compartments --_-------------_.-_-- V Distance to nearest: Well ---_ _ �- Foundation _._ ._. ----- Prop. Line _. _ ___....._ �-s-_ - - -- LEACHWG LINE r�,}� No. of Lines __ _____________ Lengtho''e line._- ° _ Tota! Length f_20---------------- I 'D' Box ��__ _IType Filter Material)_/Z_'__ pth Filter Material .__ __ _____.___ ___/..._....____ Distance to nearest- Well __ --- Foundation ------------- Property Line _ -.__----__._.__- SEEPAGE PIT Depth" � ------ Diameter Diameter - ri_-___ Number --- Rock illed Yes j Na i❑ ��jj f Water Table Depth ------------- 41- nearest; Rock Size Distance to nearest: Well .--_ . '__�__________________Foundation - --/--_-_-- Prop. Line �f:-_-_--_- REPAIR/ADDITION(Prev.,Sanitation Permit# --------.---"---_______.------------------- Date ______---------------------------) SepticTank (Specify Requirements) -------------------------------------------------------------------------------------------------------------- ----- Disposal Field (Specify Requirements) -------------- ------------------------------------------ --------------=-------------------- ------- ------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 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 j as to become subject to Workman's Compensation laws of California." Signed ----------- --- --- Owner ------------------------------------ -------------------------------------- Title r than oner) /7-F;6jPEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --------------------------------------------------------- DATE ----'f ,4_'-�----------------- BUILDING PERMIT ISSUED ------.-. __ DATE ------------------------------------------- ADDITIONAL COMMENTS -- --- --- ------------ ----- ------------------------------------------------------------------------ -------------------- ------------------------ ----------------------//----------- -------------------------------------- ------------------- ---------------------------------------------------------------------- ---------------------------- -------------------- -------------------------------------------------------------- ---- - - ------------------------------ Final -- ------------ ------- FinalInspection by, -------- -- ----- -- -- � -------------------------------------------------------------------Date ---- - ----------------- AN QUIN LOCAL HEALTH DISTRICT h s F. H. 9 1-'68 Rev. 5M ""