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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f:3 b.. (Complete in Triplicate) Permit No. � ....�. .............................. •••---......_ _. .......................... 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: l JOB ADDRESS/LOCATION ...1:_ Al-14 �...y ..................CENSUS TRACT .............. Owner's Name --r................. ............ Phone Address ..�_.. ............. .... City ...................-......-................................ -...---.......... Contractor's Name .._._.._` � _.� •• license # / � - Phone .- _.• Installation will serve: Residence 14 Apartment House❑ Commercial []Trailer Court 0 I / Motel E] Other ............... .................. Number of living units:..d._._.__ Number of bedrooms _5.....Garbage Grinder ------------ Lot Size .. L�. �!f!/�� • Water Supply: Public System and name ........................ _--._.-.-Private � 1 Character of soli to a depth of 3 felt; Sand❑ -Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam OL- Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type _ ...... (Piot plan, showing size of lot, location ofsystem 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 j J SEPTIC WANK[ J Size.._ _.._ ! 6 ... ._ ... .�. liquid Depth ...-..-••------•.. Capacity _ -� -_ Type - •_ Material...__ No. Compartments �........... Dist once to, nearest: Well .....��....-•..................Foundation ..,(�.��..--------.... Prop. Line -�_-�;� LEACHING LINE [ ] No. of Lines .... ------------- length of each line.__..g` �_. .. Total length -�}--, 'D' Box _..:,.I------ Type Filter Material .... Depth Filter Material _._ . ...........................:.. Distance to;nearest: Well ........................ Foundation ........... Property Line ............ 1 ---.._...... Depth 7 X.r>(.1,4 Diameter ................ Number ------...-- ,._._--.-- Rock Filled Yes No Water Table Depth ---�_�-r--...............................Rork Size ...... Distance to nearest: Well ................. .Foundation .. Prop. Line 4 REPAIR/ADDITION(Prev. Sanitation Permit qhs ..._.__.------------------------------ .... Date ........................... 1 Septic Tank (Specify,Requirements) ........ .................................------------.........................__._........................:..._............... Disposal Field (Specify Requirements) ..................... ..•_..___......._. --------------------------------------•- I ...................................................... ................__ .._...._... ..--••----•--------.......------------......-- --•-••-•--......__...-..-•---.......-- ................... (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. Home owner or lice s. 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." Signed _... . --------•..I - ----. O weer By ..... ------- , f __.---------.Title ..-- --....----..._...........t .r..... .. _........__......_.. ._ ' 'hf FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....-- DATE . ....'�� .--------••----••--• ......... BUILDING PERMIT ISSUED ...r.............. ..__... _ .... DATE ......._............._.. ADDITIONAL COMMENTS ................... , ....................................••---- ........... ................................ ....:.......:................... L . .!..............................I..............I.............a-------------------- ............ ......... .........I •-inal..._.._._..tion............. �� ...... Dated.._.- ... .. Final inspection by: -- g• e ----•.-- SAN JOAQUW -LOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev. 5M •y i,n 7 „