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FOR OFFICE USE: APPLICATION��FOR SANITATION PERMIT /Q 6. - -• - --- •-�-�-----....._ Permit No, .._..�.....-•�--•. (Complete In Triplicate) ----------------------------------------- _--------------- This Permit Expires ] Year From Date Issued Date Issued .�l, i 7 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 ADDRESS/LOCATION ... � ._ -._ .f --•-------..---------•--------- � Y.................. � - _ / _._._CENSUS TRACT :._ ._ Owner's Name .:._....!.f.. M - ------------.----...Phone.................................... _......._------- Address . d1--�.J-.-'F _.�!+ tom+ ...._-. City Contractor's Name _. *'sem` -----------------••----•-......-•------ •-•-••-•----......--•--.License # -------------------- ... Phone ... ......................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Trailer C=4 ,Motel ❑ Other ............................................ Number of living units_____________ Number of bedrooms ............Garbage Grinder ............ Lot Size�F' ��................_......._. Water Supply: Public System and name .............................................................._..Private-61 Character of soil to a depth of 3 feet: Sand ❑ Silt 0 Clay ❑ Peat ❑ Sandy loam-E(l Clay Loam D Hardpan ❑ Adobe C] 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 or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK 01 Size__ .public t _S.................... . Liquid Depth .................. Capacity ........ Typ- Material. -G' ---- ----------- .No. Compartments y ................. Distance to nearest: -Well .. ...'k......................Foundation ./D.'__........_-. Prop. Line {_Y._............. LEACHING LINE (, No. of Lines .................... Length of each line ------ Pa................ Total Length li? ................... 'D' Box -- Type Filter Materialo/Z............ Depth Filter Material r Distance to nearest: Well._.r4.._.3_._..... Foundation ___________ Property Line ............. SEEPAGE PIT [ j Depth ____________________ Diameter ...._..... Number ------ ......_....__.._.... Rock Filled Yes ❑ No Water Table Depth __......._•._._• ................................Rock Size Distance to nearest: Well........................................Foundation .................... Prop. Line _.................. REPAIR/ADDITION (Prey. Sanitation Permit # ............................................ Date ....................... ........... I Septic Tank j5pecify Requirements)...................................................................... ---------- ............................ .-- ------••----- ......... Disposal Field (Specify Requirements) ................................................................................. ............................................. ••••--- --------- ------------------------------------------------------------- ............. I--------•--..._.. ------._...._ _. _........................................................... .................................... -------•----•-••------•----------•----- fDraw 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 as to become subject to Workman's Compensation laws of California" Signe.-- - ... .. .....---------- I'll Owner By............................. .........................7irle _....-- other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... __ DATE ../�_C...117.:. �% .............. BUILDINGPERMIT ISSUED .......---•..............................................•----...-•-------------------•-=---------•._..DATE .-----...._..... ADDfTIONAL COMMENTS ...:.......................... . ................. ........................................................................................................................................ --------------------------------- Final Inspection by... ..: ................... - .._.Date./'.L.4t�"''._% SAN JOAQUiN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M