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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- - ----- -----•-- ----------�--- � Permit No. (Complete in Triplicate) _ ----------------- ----------------------- 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/LOCATION .------ . _469------ V "---------------------------CENSUS TRACT ------------------•-- Owner's Name ------- � f s'- d --- -- Phone Address °� ------ City ---- ,,----i---)-q-- ------------- Contractor's Name --------- ,ir �� License # 1 b t Phone Installation will serve: ResidenceApartment House[] Commercial :Trailer Court ;❑ = - } Motel E]Other --------------------------- ..!---------- Number of living units:----/---- Number of bedrooms ---A----Garbage Grinder ,f Lot Size -------------•--- Water Supply: Public System and name ----------------------------•---------------------------------------- -------------------------------------.Private Character of soil to a depth of 3 feet: Sand'0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.E] Hardpan ❑ Adobe;K 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.) NEW INSTALLATION: (No septic flank or seepage p' Pp Rubli i sewer is available within 200 feet,) 1 f it permitted if PACKAGE TREATMENT { ] SEPTIC TANK: Size- _ _ _.- --___------ Liquid Depth _-�- _--_-.___,-___ ' Capacity __ Material AY� ,-- No. Compartments r Distance to nearest: Well ------11$"P F________________Foundation 1_�-------------- Prop. Line ._.� -•-:-.-__-._ LEACHING LINE [ ] No. of Lines -------/------- Len -__ Total Leng gth of each line- -- th 0 'D' Box / '- Type Filter Material ,/5�1 �d�epth Filter Material /�_�--- -----------•-•------'----- Distance to nearest:.Well -_fes"-�_____________ Foundation _ ------.----- Property Line + e Number -.---/------------ No .0 ------ Rock Filled Yes N SEEPAGE PIT [ � Depth _�'-------_ -- -- Diameter - -,?`!.�� - , Z Water Table Depth --------A-07'-----------------•--------Rock Size .---- r�/,,f�,,� Distance to nearest: Well ----e --------------------------- d Founation _-_ rs` _-_- Prop. Line _- _+-------- REPAIR/A DITION(Prev. Sanitation Permit c# ------ --------------------=--------------- Date ---------------.------------------) 1 r s Septic Tank (Specify Requirements) ------------------ •-------------------:---------------------------------------------- Disposal Field (Specify Requirements) ------------------- ---=--------------------------------------- -------------- - --------------------------- ------------------ (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: "1 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 Workman's Compensation laws of California." Signed -------- -------- ---- ------------------------------------- Owner BY --------- =-- ------------------------------ Title ` (If other than owned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ 1nM,---- ----- - - ------------------------- DATE aha- - ------------------- BUILDING PERMIT ISSUED ----_ -- -DATE ------------------------------------------- ADD NAL CO MINTS ------------------ _: - b `� --------- -----------------� ------------------------------ ---- � -------------- --- C,�V =---- c� - ---------------------------------------------------------------------------------------------- ----------- Date -- -1 --- ---- Fifial ----------------------- - --- - Final Inspection by: �' ` ---- - --- ------- ---- SAN ------------------------------------------- - Date - SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M