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j FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1/;.. -v------------- / 6 _t,, ,-w Permit No. (Complete in Triplicate) ----------- ---------------- 11 �v t------------------ 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�ATI / - ------- - �/1..�,�---= - ------ ---- CENSUS TRACT -------------------------- s ,. Owner's Name ---t '�?.' L2 -- --- -------- --------------------------- '----------- -------------------Phone --------------------------- Address ---------------- ` a�- � I ---------- - - - ----s---------- . City C��- _-- ------------------------- Contractor's Name �7-— -----�---- -----.License # ------------------------ Phone f - r Installation will serve: ResidenceX Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -------------------------------------- Number ------------------------------ - -Number of living units:----- Number of bedrooms ---Y_.Garbage Grinder ------------ Lot Size __-________�_____ Water Supply: Public System and name ---------------------------------- ----------- ------------- Private lk Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑..`p Sandy Loam Clay Loam ❑ " y Hardpan E] Adobe E] Fill Md#erial'_ :`If yes, type ----------------- __----- __ (Plot plan, showing size of lot, l cation 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 ' _ !___-_______-_ ------------------ Liquid Depth __________________________ Capacityf TY.I?e. -�-"`--.r Materials No. Compartments ---------------------- Distance ----- Distance tto 4nearest:�Well ------------------------------------Foundation ---------------------- Prop. Line ----------.------.----- LEACHING LINE ,�[ ] No. of Lines'---------- ------------ Length of each line____________________________ Total Length ,_________-___________..._. 'D' ,Box --------- Type Filter Material ____________________Depth Filter Material ------------ ------- Distance`:to nearest: Well -----------)----------_ Foundation ______________________ Property Line ---_________•-_-_-._____ 7� SEEPAGE PIT [ ] r Depth �__________________ Diameter ________________ Number ------------------------ --- Rock Filled Yes ❑ No � Water. Tab el Depth ------- ------------- - - _Rock Size --- ----------------------- Distance-W nearest: Well ---------------------------------------Foundation -------------------- Prop. Line ......•--------------- REPAIR/ADDITION{Prey. Sanitation Permit# ------------ -_ _______________________ Date ______-______-____-__------______) Septic Tank {Specify Requirements} ________________ ___ -------- ---------- -- isposaI Field {Specify Requi m`ents} _'_____________ f �. - - __ __ ^Si T''., a .x _. - -� -�a. 'JF . _.-. _______________-___._____.____ w .._ e 11 (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 ; ---------------------------------- iBY s '`�'------------------ -----------------------_Title ' {lf ler than owner] i FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- --P.C,,- - --- --------------------------------------. DATE --�=-�--�-�--------_---- BU ILDING PERMIT ISSUED 1 -- ----DATE ------ ---------- ADDITIONAL COMMENTS ---------- ------------------- -- ---------------------------------------- i - - ------------------------------ ------ ---- - - - - Final Inspection by: Date _ — -- -- ----- ---- - - ------- ------------------ ---- ------------------ - --- --- ---- N JOAQUIN LOCAL HEALTH DISTRICT ;E. H. 9 1-'68 Rev. 5M I