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4' FOR OFFICE USE: it APPLICATION FOR SANITATION PERMIT � - ----------------------------------------- h (Complete in Triplicate) Permit No: -------------- - --------------------------------------- 1rDate Issued --------_---------------- 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 COU. ty Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATION :. 1,b /--- CENSI)S TRACT Owner's Name ------ ------ X? ---- Phone Address --------- 9'-t' 5y� --------------- City - /'' r _` ------------------------------------------•--------- Contractor's Name _. 1 = !'----------------------------- ------ Phone Installation will serve. i' Residence [] Apartment House^❑ Commercial�railer Court ;❑ MotelEl Other -------------------------------------------- Number of living units:-__-�_-_ Number of bedrooms, ------Garbage Grinder �1�-- Lot Size ------------ Water Supply: Public System and name -------- -------------------- --•----------- ----------------------------------------------------------•-----Private1w Character of soil to a depthiof 3 feet: Sand'❑ Silt❑ Clay .❑ Peat ElSandy Loam E] Clay Loam, Hardpan ❑ Adobe ❑ 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.) 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if pCublic sewer is available within 200 feet,] !, +� PACKAGE TREATMENT [ }� SEPTIC TANK P4 Size- ___ _ _ ----------------- --- Liquid Depth - ___ ----------------- Ca -----.-- ----- �1 Capacity . -.-,-- Type '@ �--- Material '/1- - --- No. Compartments _ ------------- Alp- .-_--•--- F Distance to nearest: Well -----.-� ----------------------Foundation - -------____-- Prop. Line -, .-----__-.._ X" LEACHING LINE P} No. of Lines -----0---- - Length of each line.- -------------- Total Length 1 ..........-_._--. �i De th Filter Material ,ems 'D' Box �� Type Filter Material ,f 4� P / -------------------------- ;y � r ..: nearest: Well ---7�� --- ----- Foundation C------------_- Property Line /�-------------------- Distance'-to i SEEPAGE PIT [ ] Depth __/ ------- --- Diameter _ Number --__________ _______ Rock Filled Yes, Na C3 �Rock Size ` �i;Water Table Depth it -- -� - Distance to nearest: Well --- -�--------------------Foundation __9�---------- Prop. Line ------------ 4 REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------_------- -----} e SepticTank (Specify Requirements) ----------------------------------------------------------------------------- -------------------------------------------------------------- Disposal Field (Specify jiRequirements) ------------ ---------------------------------------- ------------------------------------- - --------------------------------------------------------------------- iI {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 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 of California." Signed ---------(---- ----- -- i- Owner / —BTitle Y -------------------- --- er ; than owner] I FOR .DEPAATMEN U O LY i APPLICATION ACCEPTED IBY ------------- -------------------- -_ -- --- --------- - -------- - - ---------. DATE ---�- �--��--•---- -------------- BUILDING PERMIT ISSUED ------------------------------ -- -- --------- DATE --.. ADDITIONALCOMMENTS------------------- - ---------------------------------- ------- =------------- ------------- ------------------------- ------------------ _- q Final Inspection by °. ---Date f_.=j4 -------------------- SAN JOAQUIN LOCAL HEALTH DI PICT E. H. 9 1-'68 Rev. SM u