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FOR OFFICE USE: 1 i APPLICATION FOR SANITATION PERMIT,- k N Permit No- -----------------•--- n_ (Complete in Triplicate) ._ ---------------k----------------- ---------------------- P Date Issued _f�`"____`7-L. f 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 described. This application is made in compliance with_County-.Ordinance._No..549 and existing Rules and Regulations: I- .._ �- _�.._ ------ -------- -- -----CENSUS TRACT -- ------------ ----- JOB OADDRESS/LOCATIN /_�______ --7�____ ------------- = - F Phone ' a -. Owner's Name Address -� ",r� ---------------------- ` ---- ------- - t Contractor's Name '-- icen e #J,' ''17--- Phone Z-`�_t !n'siallation will serve: Residence__❑.Apartment..House-0-Com Trai-ler Court ',❑ tMotel ❑ Other ._ , Number of living units:----,tf____ Number"of-bedrooms .__ __Garbage Grinder ___________ Lot Sizei;___ ' '-- Water Supply: Public System and name ______________:-_ ,_ Private ----------- ------- Water Character of soil to a depth of 3 feet Sand'❑ Silt❑ 'Clay ❑ Peat❑ . Sandy Loam -Clay Looms ' lHar'clpah ❑ Adobe ❑ -- _Fill Material ____ _-__ If yes, type ----------------------------. t (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 [ ] Size--,C __ ~- -A---------------- Liquid .Depth ----4, f Capacity 1�ee-____-_ TYpe�`�4,-eM Material__L C L "No. Compartments .... ._..:.... �+ Distance to nearest: Well ---------tl_c)------------------Foundation --.Ie------------- Prop. Line -__----..--- • LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------L------ Total Length ------.----.---.-----_---- 'D' Box ------- Type Filter Material --------------------Depth Filter Material ----------------------------------••--• ! Distance to nearest: Well ____________________ Foundation ------------------------ Property Line --------------- --------- O n SEEPAGE PIT [ ] Depth _ _____________ Diameter ��_, 55 Number ------._l---------------- Rock Filled Yes 0' No .0 WaterTable Depth ------------------------------------------------Rock Size ------------------------------- ] I Foundation Prop. Line ...$_'"--------- Distance to nearest: Well .___-- -- REPAIR/ADDITION(Prev. Sanitation' Permit# -------- ----------------------------------- Date -------------------------..-------} Septic Tank (Specify Requirements) ------ -------------- ---------:----------------•- ---------------- Disposal Field (Specify Requirements) ----------- --------------------------------------------•--------------- --------------------------------------------------------- ---------- --------------------- ---------------------------------------------------------------------------------------------------------------------- # 1 {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 --------------------------- ----------------------- --------------------------------------------- Owner B Y '�1 I -------------- 1 itle (If other than ner)! i FOR DEPARTMENT USE ONLY t ------------- DATE -----/J--- -�--------- APPLICATION ACCEPTED BY --- .- - ---- r._.�.:-.�.-�_-.-- ---•- ------=--------------------------- - -- BUILDING PERMIT ISSUED ----------=t--------------------- BATE ------------------------------ ADDITIONAL COMMENTS.--------------'------------------ ---------,---------------------=--------------------------- -- ------------------------------------------- t ------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------- ---_----)---- -- ---------------------------------------------'----- ------------------------ --------------- -- ------------- Date = - -- Final!Inspection b `��>- ��' SAN JOAQUIN 'LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M, G