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FOR OFFICE USE: l 1 ,. APPLICATION FOR SANITATION PERMIT ' ! Permit No:7------------------ ---------- _/U (Complete in Triplicate) ---- ------------------------=-------------------------- _.--..-.___.___ _ ' __-.____._____ ___-- This Permit Expires 1 Year From Date Issued Date Issued 2�.��_-7U 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. 349 and existing Rules and Regulations: JOB ADDRE5S/LOCATI JJam� ----- Z- - - -------- --+--CE.INSt US- T �R, ACT7 ------ --- Owner's Name --------------------------- ----------Phone 7----- Address --------- ---- ----- - - - city - � ' e-------------------- Contractor's --- Contractor's Name ----------------- - --------- . s # _ 3� a� Phone ------------------------------ Installation will serve: Residence Apartment House f] Commercial❑Trailer Court ;❑ Motel ❑ Other - ----------- Number of living units:_________ Number of bedrooms ____:_______Garbage Grinder _- _ Lot Size _.___ Water Supply: Public System and name '------------------------------------------------------------------------------------------f------------•--._.Nvate ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'❑ 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 tank ar seepage pit-permitted if public sewer is available within 200 feet,] PACKAGEt TREATMENT [ ] SEPTIC TANK'j ] F Size------------------------------------------------ Liquid Depth ---------------------_---- Capacity ------ Type -----------1 Material--------------------- No. Compartments -----------------= t Distance to nearest: Well _____.'____.- ---------------- 1Foundation ______________________ Prop. Line _____________________ ------ LEACHING LINE [ ] No. of Lines --------------------'__•_ Length of each line------ -.------------------- Total 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 0 Water Table Depth ------------------------------------------------Rock Size -------------------- # k Distance to nearest: Well ----------------------------------------Foundation -----_---- --------- Prop. Line --------------_----- REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ----------------------------- Date ---------------------.___________- Septic Tank (Specify Requirements) ------------------------------------- ---- _ --------------- -- ----------------- - Disp sal Field (specify Requirements) �-�@ _ ` '- - Ll- W1 1C1 X .K-19 ------------------------I--- ------------------------------ -------------------------------------------------------------------------------------: -------------------------------------------------------- ."I (Draw existingand 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 as to be co subiect to Workman's Compensation laws of California." Signed ----------------------- Owner BY ------------1:- F ------- L Title Of other than owner] y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I3Y `' L' '� . DATE _ �lln BUILDING-PERMIT' ISSUED ^------------ -- - DATE----_ ----------- - 4 -- - ------------------------------ ------ -- - ADDITIONAL COMMENTS ------------------ ---------------------------- ----- ----- ---I-------------------------------------------------------------- ----------------------------- ------------------------------ --------------------------------------------------- ---------------------------------- ----- - ---- -------------------------------------- --- ----------- Final Inspection by: Date SAN JOA UIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M• i