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�.• - , ... ... ire FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .......... .......... ... f .......................... Permit No.....�� `.14.Z (Complete in Triplicate) .... ...... ......... ............................. Date Issued ... I This Permit Expires 1 Year From Date Issued Application is hereby made t6 the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is mode in ni I' nc w't Co i Or a 549 and existing Rules and Regulations: IF t �. �� JOB ADDRESS/LOCATION .eP zf.!?^ �- I. ...`1.. .__._..�```'-�..:�-.�o-."(.G"�,' NSUS TRACT q.c.................. �J Phone ................................... r"l q....__.... Owner's Name •::_..t...-c�-•G�..._... �(..............�..,......................... .. - Address .--.. ..... • C0 • _............. i..f.:........:...__:. ....... 1 ..... ............... ..................... 1� c City ..... .................... ...... J p3$s— Contractor's Name License # ...$ ..: •- ......._. Phone .. .......................... i Installation will serve: Residence Q Apartment House C1 Commercial ❑Trailer Court -.0 -- • i Motel ❑ Other ....... ::.................,...._._...__... s .i'.'.... Gdrbage Grinder ....'.!... Lot. Size ........................ ............. Number of living -units:........... Number•of''bedroom ` ' Private 19- Water � Water Supply: Public System and name ............ ' -•-• ................................................................ Character of soil too depth of 3 feet: Sand :E] Silt ❑ Clay FPeat ❑ Sandy Loam {' Clay Loam.0 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.) r � t NEW INSTALLATION: (No septic tank or seepage pit permitted if `public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK -11 Size ... ............ Liquid Depth _..... �.->� ---`!� ...------'--•---• --- -- Ca aci .. ::... TYpe.•----- .._... Material ...................... No. Compartments e ?. i Distance to nearest: Well .............. .........i._._:....Foundation ...................... Prop, Line ....l.....__.._....... Total Len LEACHING LINE [) No. of Lines ... ........ .......... Length of each line ............... ..... gth - --I I 'D' Box ............ Type Filter Material .._..............__Depth Filter Material ............................................ Property Line t - -- Distance to nearest: Well _.................... Foundation .... ........ ....... .. p ty .•..........._...-...-.. SEEPAGE PIT [� Depth `5.�... Diameter _..��.•.•- Number ....._?................ Rock Filled Yes '[5/No ❑ i¢......... •----......_.......Rock Size ....o? ................•--- Water Table Depth . ........... .... , Distance to neareV.- Well-).. ........... f -•-•_.._.._Foundation .._...-.�'- �..... Prop. Line ...................... REPAIRfADDITION (Prev. Sanitation Permit #-.....-- 1.... -, --r ' Date --- ............ .................. ) Septic Tank (Specify Requirements)!...:.................t_..........:...._.._......__.. . ..........................:......................... _!....... Disposal Field (Specify Requirements) •..... •.• -•"•' ................ .............. .............................. ........... ... f1 ....................... {Draw existing and�re.quired 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 Rulos and Regulations of the San Joaquin Local Health District. Borne 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 persot► in such mannQr as to become subject to Workman's Compensation laws of California." Signed .. Owner ' �r By...... .......... _.......... ._.. ff vtc,.f....:t^`-?°,1-:... Title L ............ (If other than owner) (� FOR DEPARTMENT USE ONLY j _ - 7/............ APPLICATION ACCEPTED BY a' G�� n�u-t. .......... DATE .._ ....... - BUILDING PERMIT ISSUED ........... DATE ....... ........ .....:................ ADDITIONAL COMMENTS . ....... .... ................ ..... . ...................... :.......................... .........I ........... ....... ......................... .......I . ....... ........ .......... ..:. .. .: .4........ ........•....... I ....... ........ .... I .... ......... ....... Date ..... . ...... Final Inspection by: �r<!.. ..._... `....... ....... ..... ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1 •'68 Rev. 5M