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FOR OFFICE USE: / APPLICATION FOR SANITATION PERMIT Y - Permit No: - (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Dote 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 complia re with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ 'L - CENSUS TRACT , r Owner's Name _ .-E- ii LL-r ---------------Phone4 _:-7- �-------- Address Z ---- -a- ---- } _I � Ci,�..� C-------------------- ---- ----- / / f ,� -----;-License # ------------ Contractor's s t r=*` IC�GJ ' Name -------PA. L _ _ c---S a ---------------- - Phon Installation will serve: Residence Apartment House❑'Commercial❑Trailer Court ❑ Motel E]Other ----------------- ------------- -y7---•- � - f k Number of living units:c_t_�_ r_ Number of edrooms l —)---Garbage Grinder O--- Lot Size 'Z!j - ----------------- Water Supply: Public System and name ---. --------Private El___ _ "_"_"_�.�--=1�----�-�Y�=�-�----(�--�-- -• ; t --�- , Character of soil to a depth of 3 feet. „Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe X1 Fill Material ----- ------ If yre;, type ---------------------------- W (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} �I NEW INSTALLATION: (No septic tank or p seepage pit permitted if public sewer is available''within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size------------------------ -------- ------------- Liquid Depth --------------------------- Capacity --- 4------------- Type -------------------- Material------ --------------- No.' Compartments ------ ---------• a : Distance to nearest: Well ------------------------------------Founclat'ion ---------------------- prop. Line -----"----------••---- LEACHING LINE [ ] No. of Lines ------------------""_-_- Length of each line `--------,- ------ Total Length ,--------------------------- D' Box -_____. ._-. T e Filter Material ___________________Depth' Filter Material _____-____-___ YP Distance to nearest: Well ----------------------- Fourclation:.------------------------ Property Line ------------------•---.- SEEPAGE PIT Da th - Diameter { "R- -------- Rock Filled Yes No 1 p Number -- ❑ i Water Table Depth ------------------------ -------------•--------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundatioit ---------------•---- Prop. Line -------.-------------- REPAIRfADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) I ) Septic Tank (Specify Requirements) =------------------------ -------------- ----------- = --- - - -------------------------- Dis sal Field (Specify Requirements) ------ --------------------------- ------ . ---------------------- ��t� -- -- - ----------------- -- - -r i . - --------- _, '' -t:. l _ J - ---------------------------------------- --------------------------------------= (Draw existing and req ired 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 certythathe performs ceof the work for which this permit is issued, I shall not employ any person in such manner as to blect'taWo man' •Compe ation laws of California." Signed � OwnerBy ------ `" ---------- Title __ �r - _eof er than owner) R/ FOR DEPARTMENT USE ONLY ------------------- 2z G APPLICATION ACCEPTED BY ------------------- ----- ----- DATE __ _ I BUILDING PERMIT ISSUED ---------------------------- --------- DACE - ADDITIONAL COMMENTS - -�P--=-�"�:-�-�-.:,------ ' - - - -- ----�--' -----�'��•----- ------------ -- ------------------------------------------------------ T �'' f--------- '-��"" 1 --------------------------- --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----_ Final Inspection by: --- j� - Date ------ C�1'�" -•-- - -- - ---------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.