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r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No... (Complete in Triplicate) ......................_.. .................. ..�`r..':�� ........ ......_......... .----- . __.-._..--- � 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. JOB ADDRESS/LOC ION .IV16.:yz... .-•--_ A_ - _....... I.............. -.CENSUS TRACT -..--...,1 ....... OwnersName ---/..Q .r ........��- r`-------------- ...... .... _...... .•• .......:.....•--•------... Phone .......... ............. Address---- l--6.6Y2...... . ..-•---- __ City .... ...................... ............... •-....-..•..•...--- Contractor's Name.....DIrIL�'�fF--�'c........-.,��ent ..... __.............------...License # __....----........ . Phone .._. ................Installation will serve: Residence House ❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other_. ......... . -------- -------- Number ---- --Number of living units........... Number of bedrooms .......Garbage Grinde .- Lot Size 14CAF-667- .... Water Supply: Public System and name...........................................---...........__._.._....................__ ----------................. Private Character of soil to a depth of 3 feet. Sand 0 Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loom 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.] t NEW INSTALLATION:)' (No 4eptic tank or seepage pit permitted if public sewer is avoi ble within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK V] Size - _................................... Liquid Depth ................... Capacity ................... ype ............. Material......_,_------------- ,---Distance .,,- -�.,. No. Compartments .................. _7_ ,_ _ - Distance to nearest: ell, :........................... _. _..-Foundation ._..._... Prop. Line ...... ..�.....------- LEACHING --- -LEACHING LINE ['J No. of Lines ------ ------- ________ Length of each ------ .. _ Total Length 'D' Box Type filter �Aaterlol ...... .............. Depth Filter Material ..... -__-_..-............... ................ Distance to nearest: W II ` �..................... Foundation __ _..........--------- Property Line ... -.................... � SEEPAGE PIT [ ] Depth .................... Di meter ...._........ Number ._............--- ---- -- Rock Filled Yes 0 No i❑ Water Table- depth .................... ........................... Rock Size _ Distance to nearest: W . ......................................Foundation ....-.__..... Prop. Line ----------......---•-- REPAIR/ADDITION (Prev. Sanitation Permit # ................................. Date .............. . _..-..__._...._,..) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ---- P/.S7_...: B-pA............. ._Q"14------- Njp. .`.-:..... ON ............. �...-.....�i�1.... _ .._....T.. ..................... (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 age sl9nature certifies the f wing: "I ce h tat in he a the work for which this permit is issued, I shall not employ any person in such manner as to be o e bloc to orkm s Compensation laws of California." 4 Signed . -:.................................. Owner By--------------------- ---------............ ...._.............. -1"i.p�`Zr Title . _... ....... ------- •-••........... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- 7t_R.x0e....---....._ ....... .. ............................................ DATE ..,._ '... ��_.� •-•---. BUILDING PERMIT ISSUED .... ........................DATE.....-_.............._...••--•-•• . ..... ADDITIONAL COMMENTS .. - ... ................................ ._�. =•-- ~ ' ' �. �� ............._...... ....................... _. ,. ___ — .........---•............................ .... — ' Final Inspect .........bate .... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M