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FOR OFFICE USE: h APPLICATION FOR -SANITATION PERMIT �� 37 Permit No. ___ ----- (Complete in Triplicate) ------------------- --- . ........ -----. Date Issued --- This _This Permit Expires 1 Year From 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/LOCATION --------------4-------- -'------6"-�� {` l '-V[ -- CENSUS TRACT Owner's Name ------ --- r-5----------- � ------------------------------------------------ ------Phone Address -- --------------- i` r V d C------------------------ City --- ---------------------------------------------- r- ----------------- -------------------------- _f_ Phone Contractor's Name _�_��--_l�_��-��-- -�'�--��t��"--�Q�-�_�_e_.License # --24.�--�-- - Installation will serve: Residence ErApartment Hous e'❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ----- ------------------------•---- Number of living units:----4____ Number of bedrooms ___ Garbage Grinder !0-___ Lot Size ---X ----------------•--- n •- Private ❑ Water Supply: Public System and name _-_____-f``v_- - -I__�_._-- --------•-------------------•------------------ Character of soil.to a depth of 3 feet: Sand'o Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe X Fill Material ------------ if yes,type _________------------------ (Plot __ ______________(Piot 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 ( I SEPTIC TANK' 3 Size-------- -------------------------------- - Liquid Depth -------------------------- Capacity ---- ---- -----E - Type -------------------- Material---------------------- No. Compartments ---------------------- -- Distance to nearest: Well ------------------------------------Foundation ----------------- ---- Prop. Line ------------------•--- LEACHING LINE [I/)/ No. of Lines _________ ------------ Length of each line-------- 0--------- Total Length ----- �.1------------ 11 'D' Box ---- .._-- Type Filter Material -------9_- -----Depth Filter Material --------11�---- --------------• -•------ n/ Foundation _____--�-------- Property Line _____ �f-------- Distance to nearest: Well __1 v-�t-j}-LQ-,-!/ Y No SEEPAGE PIT [M/ Depth -----n1-�_----- Diameter _ _ ______ Number ________l______ __��Rock Filled Yes Er Water Table Depth -------------l--Q---------------------- Rock Size --- --• J Distance to nearest: Well ____N6n_ ___________Foundation ------/�--�-_ Prop. Line ___�----- -------- EP IR, TION rev. Sanitation Permit# ------------� ---------- --------- ------- Date -------------- ) Septic Tank (Specify Requirements) -"--------------------------------- Disposal Field (Specify Requirements) --------------9--io- '-•--- `-- ------ --------------------------------------------------------------------------------------------------------------------------- --------------------------- (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, Stare 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation I of California." Signed __ _ `� -------- Own --------------- -Title --------- ---------- ------------------------------------------------ Y __.---" (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----� .� - --------------------- DATE _ -----�--�--- - ---------- ----------------------- - --------------_ ---- ---------- -------DATE -------------------------------- -----"---- BUILDING PERMIT ISSUED ------ ADDITIONALCOMMENTS ------------------------------------------------ ----------------------------------------------- ----------------- ----------------------------------------------------- ,-- --G_-k-----7 A-; ---------- ! ------------------------------- -------------------------I----------------- !� Date ------ - ------- Final Inspection b SAN JOAQUIN LO AL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M