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d FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. ------------------ - ------------------- ----- Permit No. .. .. (Complete in Triplicate) . Date Issued --- ---------_---------- ---------------------- This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. JOB ADDRESS/LOCATION ..-.49.3- �-----��, JI��I� J�.1�/-�°------- -- -----CENSUS TRACT �_!-- -•----------- � T ----------------------Phone ----------------------------•--•---- Owner's Name - ', 47- p ------------- -- tv Address -------------------5 - - ------ ------------------------------------------------- Cit !-p--- --------- --Phone i��-- iZf� �� /ateQ Li ease # ir _ Contractor's Name --..-- -�j i� � .. Installation will serve: Residence [Apartment House F-1Commercial OTrailer Court ',E] ) f Motel F-1Other -------------------------------------------- Number of Irving units:-----/---.- Number of bedrooms -9------Garba-ge Grinder -------- --- Lot Size -_-„ Q-. `'S`-F� Water Supply: Public System and name ------------------------------------ -----------------------------------------------------------Private l�] Character of soil to a depth of 3 feet: Sand'❑ Silt C1 Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ i 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.) 1N `• NEW INSTALLATION: iNo septic tank or seepage pit ermitted if public sewer is availab a within 200 feet,) V PACKAGE TREATMENT [ -SEPTIC TANK'[ ] Size--------------------------------------------- -- Liquid Depth -------------------------- U . Capacity ---`-- ------------- Type ----- -------------- Material---------- ----------- N Compartments -----------.....------ v Distance to nearest: Well ------ - --------------------------Foundation --------- - -------- Prop. Line -----------.-..,------ LEACHING LINE [ j No. of Lines ------------------------ Le igth of each line--------------------------- otai Length 'D' .Box ----}------- Type Filter Mai arial ---------r"_-.-------Depth Filter Mate ai -------------------------------------------- --- Foundation per Line -------------- -- Distance to nearest: Well --------- ---------- ----------------------- Property - ------- SEEPAGE PIT Depth Diamete - _----_------- Number ----------------------- _ Rock Filled Yes ❑ No '� { � p ------a------- Water Table Depth ----------------- - ---------------------------Rock Size ---------- ' Distance to nearest: Well ----------- ---------------------------Foundation ---------- -------- Prop. Line --------•.--------- REPAIR/ADDITION(Prev. Sanitation Permit r# --------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------- j O -- --- --------------------------------------------------------- QD 7------- - to------------------ ----- --------------------- --- --------------------- Disposal Field (Specify Requirements)`-_---�-------------- = ------�-- - ----------------------------------------- - - – =----- ----------- -------_.--------- ----------------------- - ---- — ' (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 �loltl � Owner BY . ---- ---- ------------------- Title --------------------- ----------------- -------------------------------- f of er than ow FOR DEPARTMENT USE ONLY 7 7z� APPLICATION ACCEPTED BY -- �I-' -------------------- --------------- --------------------------------------- DATE -+-- ------------------ BUILDING PERMIT ISSUED ----------------- - ------ - - ---------=------ -----DATE ------------- ----------------- ----------- ADDITIONAL COMMENTS - -- ----------------------------------------- ----------- -- -------------------- ---- - -- --- ------ -------- -------- ---- ------------------------- ---_--- ----- - = -------------------------------------------- ------------------ Fina! Inspection -------------Date --- ------------------------------- - -�----- ----------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M