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=<FOR;,OFFICE USE: 44 5-IT -z APPLICATION FOR SANITATION PERMIT - i---------------------- (Complete in Triplicate) Permitfio.r :�1 - --7-5.. ------------------------------------------ --------------- This Permit Expires 1 Year From-Date Issues! 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 ADDRESSAOCATION ------40- ---lev----- ----------------------------- CENSUS TRACT ._ Owner's Name `: /��nl / 1L�-' --•---- Phone - 1 _.. i Address ' -------- City - h Contractor's Name -- �1��= ��r�(�------- ------------------------License # /�7 �J-- Phoneme/= �?7 ... Installation will serve: . Residence ❑Apartment House❑ Commercial :❑Trailer Court e� t Motel ❑Other Number of living units:________ Number of bedrooms ----------Garbage-Grinder - '_ Lot Size - _ ------------------------- Water Supply: Public System and name ______--------------------_ '» � ------- ------------ ---------------------•--------------------•-------------..Private [] Character of soil to a depth of 3 feet: 'Sand' ' ❑ Silt'❑,r r Gay .❑ Peat❑ Sandy Loam ❑ Clay Loam .0 Hardpan ❑ - Adobes 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.) ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK [ 1 Size----------------------------_------------------- Liquid Depth ------------_-----_----- --- ------ Type -------------------- Material---------------------- No. Compartments Capacity J Distance to nearest: Well ------------------------------------Foundation ---------- ----------- Prop. Line ---------- LEACHING LINEI [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length +.� D' Bax --- J------- Type Filter Material ____________________Depth Filter Material Distance to nearest: Well -------------- ------ --- Foundation ------ ------------- Property Eine. ------------------------ SEEPAGE PIT [ ] Depth. --..-.- --- -------1- Diameter ---------------• Number ---------------------------- Rock Filled Yes ❑ No ❑ Water Table Depth ------------------------------------------------Rock Size -------------------------- ----- � , FF Distance to`nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _._.----------------- REPAIR/ADDITION(Prev. Sanitation Permit# __________________------------_______- -_ Date ---------------------------------- Septic Tank (Specify Requirements) ----------_________ Disposal Field (Specify Requirements) ___I,7-C3 aC_-__ _ _;(O--__ ' -- --------------------- -- ------------------------------------------------------------------------------------------ (Draw existing and required addition on reverse side) tion and that the work will be done in accordance with San Joaquin 1 hereby certify that I have prepared-this applica4 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 ofPthe work for which this permit is issued, I shall not employ any person in such manner as to become sub'ect to o kman's Compensation laws of California." Signed . ) -- - - -- ---- ----------------- Owner BY `------- - -- --------- Title �(If of h: than owner! 1 F EPARTMENT USE ONLY APPLICATION ACCEPTED BY �t --------------------------------------------------------- DATE ... ..rl� � BUILDING PERMIT ISSUED _____._ - - ��` _ ----------- --------------------------------------------;--------------DATE ------------------------ ADDITIONAL COMMENTS -- - ------------ i ---- -------------------- ---------------=---- r ---------------------- -- -------- ----------------- -------------------------- ------------------------------- Final Inspection by. - - ------ - ---- - �-T-- -- � -------------- - ----------- - ------- --�--------- - - ----------� - ----.Date -- ----- -- --- ----- ------- SAN ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M