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{ FOR OFFICE USE: - �..,.gPPtICATlON FOR SANITATION P T ----------------------- " __ ------ (Complete in Triplicate) ermit No. ._SC' ------------------------------------------- This Permit Expires 1 Year From bate Issuetl FILI COD to 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/LO ON . / ,Q-- " Y u � `" -CENSUS TRACT Owner's Name ._ " " --- ' � -- -- ----'-- ------ ------Address -- 1 ®- one ---- -- -°--- - city zre - Confractor's Name "--- + > 4 ----------a- License # i t � _ hone ------- ---------- Installation will serve: Residence Apartment House-[] Commercial:❑Trailer Court Motel 0 Other Number of living units------ ____-- Number of bedrooms ---Garba_ge Grinder ------------ Lot Size Water Supply. Public System and name --------------------- PP Y� . _ - - - ---- --------- ----------------•---------------,------- •--------_Private Character of soil to a depth of 3 feet: Sand i!t[] Clay ❑ Peat❑ Sandy Loam E3 Clay Loam iv .. be'❑ Fill Material if es, e _. ----- Y ty Hard Ado (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'[ ] Size_______________________ ---------------------------------------------..- Liquid Depth -------------------------- Capacity - ------------- --- Type -------------------- Material------------- ------ No. Compartments ------ Distance to nearest: Well ---------------------------------------------------•-----Foundation ----------------:-----" Prop. Line ---•----'=--==-- •---- LEACHING LINE [ ] . No. of Lines --"___--------- ------- Length of each line -- - "--- Tota! ;Length - - ---------------------------- D' BOX-_"-_-___._- Type Filter Material ____________________Depth Filter Material�_:__.____.____ --------------- -----•---- Distance to nearest. Well -__________________--- Foundation Property Line SEEPAGE PIT ---------•-------------- • [ ) Depth ------------------"- Diameter.E---------------- Number ----------------------------- Rock FilledYes '[] No Water Table Depth----------------------•---- ----- -------Rock Size Distance to nearest: Well -------------------------------------- FoundptionProp. Line ----------------------4 REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- -------------------------- Date -- ------------------- Date . ) Septic Tank (Specify Requirements) ------ -_---- ' -------------- '' --------- -----------------------•---------"--.--------------- ----------- Disposal Field (Specify Requirements) _--__ _- - �� r -- . --- -- --------------- - - --- ---- -- - -(Draw existing- and re q uiced addition on reverse si I hereby certify that I have prepared this application and that the work will be one 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 beco subject to Workman'—SC-0 mpensati.on laws of California.,, Signed --_- i---- --- Owner "� Title - (If other than owner) - -�"''------Y--- ----------- - FOR DEPAitTMENT USE ONLY APPLICATION ACCEPTED B�__ _ BUILDING PERMIT ISSUED --------------- --_---- -`11,41------------------ -------- ------ DATE -•---------------- ADDITI ONAL COMMENTS - -------- -------- --- ------------------"----------- -------------DATE -- ---- -----"---------- - ----------------------------------------------------------------------------------------------------------------- -------------- ---------------------------------------------------------- ---------- ------------ -- `'------------------------------------------------------------- ------------------- -- Final Inspection b ----'-- - -- - _ ------ F --------------------•---•-------- ----- - - ---------------.Date _ � 24 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M