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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 6 . (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/LOCATIONN�_./____ _ _____ / _c .� _ .__CENSUS TRACT ----________________•_-_ Owner's Name !✓ [----._.--•-G� ------------------ ---------- - � ��_�_��... Address S 3 � _ hone -_ _._ __ _.._ __ f ----- G'; City n! g Contractor's Name _. <.- -__........License # _ Phone __ _______ ____ Installation will serve: Residence 5Z Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ---------------------------- ------------- Number of living units: _ Number of bedrooms __CR-____Garbage Grinder._. Lot Size - �_.�-G-_'_��' /-___. Water Supply: Public System and name ---------------- ----------------------------------------------------•------------------•--------•--.--P\riva/tem Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat E] Sandy Loam E] Clay Loam`s / Hardpan E] Adobe F] 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 ize'-L___�cz --- -__.__ Liquid Depth __1V......•......___ �t Capacity � _- V---__- Type .- ��'__ Material_(.... --- No. Compartments ------- --.-.-- Distance to nearest: Well -_.1 ______________________Foundation f.U.____.---___ Prop. Line __�---__?? LEACHING LINE ' No. of Lines _ _ _ _ ----- ._ . Length of each line-.._ k , g -9 ll �-`° Tota! Length - ---�-------------- 'D' Box ...__ _. Type Filter Material Filter Material _ _________________ ______�._.. '�Distance to nearest: Well �..,�.._ -_______ Foundation le),______________ Property Line -.___.._..____4-, SEEPAGE PIT Depth Diameter ------- Number _ ------- ------- Rock Filled Yes No -------- Water Table Depth ----------- ---------------------------Rock Size -------------p / t � Distance to nearest: Well -_._.t 0.....................Foundation -_�-------- Pro Line REPAIR/ADDITION(Prev. Sanitation Permit# _.______.--______________ ------------------ Date ________.--.-----_--____________-_) 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. Dome 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 f California." Sig d . A---------- -- - Owner !_... BY - -• �-�`- itle - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------r-----------•--- f - --- ---- - - - -•-•- -- DATE �1 6 BUILDINGPERMIT ISSUED -------------------------------------•-------.----------------------------•------•--•--------------------DATE ---------------------- -------------------- ADDITIONALCOMMENTS ---------------------------------•------•-••----••---•------------------_._------•------------------------------- -- -- ------------------•------------------- --------------------------------- ---------------•---------•-•---------•----------------------------------------------.-.-•--••-------•--------•---•-•--- ------ --------------- 1 ---- --------------------------- -------•-•------------- ------------------------------•-------- ----------- ]Final Inspection by: � (_ 2 - -- - f-- -------------------------------------------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M