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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- - {Complete in Triplicate} Permit No: --------- ----------------------------- This Permit Expires 1 Year From Date Issued Date Issue 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. 5.49 and existing Rules and Regulations: led JOB ADDRESS/LOCATION `- = ------------------------------------------------CENSUS TRACT ------------ ----• • - �j Owner's N me +I - - ---- '• Phone -------- ------------- ^�a-4) �_�l�� ,.�p Cit �"'��4------------------------------------------------- Address 7-� e`Jr �y f1. Y Contractor's Name --- l--- -----�`�- -et-l-CG--___--Affk---d_K%nse Phone Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court l❑ Motel ❑ Other - ------------------------------------------ Number of living units_____________ Number of bedrooms -_-s _____Garbage Grinder ___i..... Lot Size - - ---L4 ________-________ Water Supply: Public System and name --------------------------------- ----------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam] 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size----------------------------------- ____-------- Liquid Depth -------_---.________._.__. Capacity ---- ----------- --- Type -------------------- Material---------------------- No. Compartments ------ -----------_-- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------------------_ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ------ --------------------- V Box ------------ Type Filter Material ____________________Depth Filter Material -----------------------------I.._____.____-_ Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------...... ._____ SEEPAGE PIT [ ] Depth - ____ ..---------- Diameter ---------------- Number ----------------- --------- Rock Filled Yes (] No Water Table Depth --------------------------------------- --------Rock Size -------------------------------- Distance to nearest: Well _._____________________________________Foundation --------------- ---- Prop. Line _____.____.....__...__ REPAIR/ADDITION(Prev. Sanitation Permit -------------------------------------------- Date ------- ------- Septic ------Se tic Tank (Specify Requirements) - ,� .�----------- Disposal Field (Specify Requirements) +' ------ _-.I-- ----------------------------------------------------------- ------------------------------------------------ ----------------existing required addition on reverse side) t I hereby certify that I have prepared this application and that the work will be done in accord6nce 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 - --- -- -- ------------------------------------------ A117` J BY - Title , ,. (If other than own l .l FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY DATE _` 2!a` 4 ------------------ - BUILDING PERMIT ISSUED ----------------------------------------------- ---------------------DATE -------------------------- ----- ------------�------- ---------------- ADDITIONALCOMMENTS ----------------------------------------------------------------- ------------------ -- -----------------------------------------------------•-------------- ----------------------------------------------------------------------------- --------------- t------- - --- --------------------------------------------- ------------------------------------------------ ------------ ----- Final Inspection by: ` ------------------------------------------------------------------------------.Date :�j"_'70_-__ti SAN JOAQUIN LOCAL HEALTH DISTRICT L E. H. 9 1-'68 Rev. 5M