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FOR OFFICE USE: Q APPLICATION FOR SANITATION PERMIT y " � 7 •l ' (Complete in Triplicate) Permit No: .-J-L.__.________. ----------------------------------------- _ _ --- ---- --- - This Permit Expires ] 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/LOCATION ------ TRACT -------------------------- Owner's Name f --- •---- . ------ ---- ----- -- --�------------=•Phone-_�------- �' Address ---- l2. ". Srry t Y --------------- -- - CittC ' �. Contractor's Name c-a.1P, -_ P-------------License # Phone Installation will serve: Residence ❑Apartment House�❑ Commercial :❑Trailer Court I❑ Motel ❑ Other - - i ----ST5-�-1 Number of living units: Number of bedrooms "-- -----Garbage Grinder ------ ---- Lot Size ----�� Water Supply: Public System and name -----------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑_ 'Sandy Loam ,E] 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 sewerf.is available within 200 feet,) ------ Liquid Depth --- ��--------- - PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size----------- ............... q p t :� Capacity - 0.,C> Type ts_G'e� -Material___ No. Compartments .._ ._.__.._._. 00 - Distance to nearest:-.Well -------/642-�-------------------Foundation ----Z-0 Prop. Line ... -------------- D LEACHING LINE [ ] No. of Lines g__` --------------- Length( of each line Lt __--- -tea___ Total Length ,_ ._7Q______________ 'D' Box Type Filter Material _.f.zr_ --_Depth Filter Material ------ ----------------------------- A Distance to nearest:'Well ---- 0 1 . °------_ Foundation•----. O`t ---- Property Line ---s ---------------y Rock Filled Yes No i [;l P ------.`Diameter _ ------ Number -..-----�'- Ip SEEPAGE PIT Depth _�_. --- ------- -- r e � Water Table ,Depth ------- . -----------------------------------Rock Size v' ri L--•--- Distance to nearest: Well --_l _n_ .t-------------------Foundation _.gip. ____ Prop. Line -- ............... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- --------- -- Date ---------------------------------- 1 Septic Tank (Specify Requirements)------- �. p------------`------------------- --------------------------- - Disposal Field (Specify Rquiremen ts) '---------------------------•- ---------------------------- ---------- ---------------------------------------------- ----------- -- ---- -- -- --------------------------- (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: a "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to beco subje to Workman's ompensation laws of California." 1 Signed - ------ Owner c. By ------ - ---------------- ---- TitIe (If oth t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY r ---=------------------- ---- ---------- ----------------- (DATE ' �/ --------------- ------ BUILDING PERMIT ISSUED ------ t----------------------------------------- `-------------._ _-DATE -- -------------- ADDITIONALCOMMENTS -----------------------------------------------------------•------------------------- ------------------------------------ --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=%; -------------------- ----------------------------------------------------- --- ---- ---- ----------- Final Inspection by _ /* 7 th,:.. ____ ' ------------------------------------------------------ f� SAN JOAQUIN LOCAL HEALTH DISTRICT ~ E. H. 9 1-'68 Rev. 5M