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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------- Permit No. p (Complete in Triplicate) ---------=----------------------------------------------- ------------------------ -------- 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/LOCATION ----1/75�'l.Y___ ------------------ _CENSUS TRACT -------------------------- Owner's Name _'--------------------- ne -----—---------------------------- Address _:�_1_ g- lL � -Q� V-----. City _�Pfi�i-,--- � � ' Contractor's Name _121E� --_ 1,, --------->License # Phane Installation will serve: Residence ❑ApartmentOuse,❑ Commercial- f:]ailer Court Motel ❑ Other I -------------------� Number of living units------------- Number of bedrooms ----------- Garbage Grinder ---------- Lot Size ___,-._-_-__.--__----_-___-_-__.--_-_---_ Water Supply: Public System and name --------------------------------------------------------------- ----••--••----------------- ------------------Private 1 Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ 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.) J NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ] ] SEPTIC TANK'[ ] Size---------------------------------------- ------ Liquid Depth --------------.._..------- - jC(S6�� Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -----------------------� ' Distance to nearest: Well ------------------------------------Foundation ------ -----------------.--_______ Prop. Line __-_._-_-_-------__-_- LEACHING LINE [ ] No. of Lines ----+�--------------- Length of�ach line_��_:�¢P.___._ Total Length ----- <e . 'D' Box . ��?�3_._ Type Filter Material Depth Filter Material __- - /?-------------------- ----------�' Distance to nearest: Well --- Foundation ---/0 Property Line __- ----.-_-_- r. SEEPAGE PIT [ ] Depth _12'�---__._ Diameter _44J&----- Number -------t--------------------- Rock Flied' Yes 0 C. Water Table Depth ---------- - ------------------------ --Rock Size Distance to nearest: Well ----- - -------------------Foundation ---/_0 ------ Prop. Line __. ......�� REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------------------------------=--------- rDisposal Field (Specify Requirements) ----------- ------------ ^ cr --- --------- -------------------------------------------------------------------------------------------------------------------------------------------------- (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 1pooct to Workman's Compensation laws of California." Signed - -- --- � - -- -- --.�- � Owner/ Q BY Titlef '� ------------------- --- -- -- --- - - t./ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _ -- -- -_.-- ------------- DATE -- _-� - - ---- ._____---. ---------------------------------------------------------------------- BUILDING PERMIT ISSUED --- --µ---------------------------------------------------------------------------------------------DATE ------------------------------------------ ADDITIONALCOMMENTS ------------------------------ ----------------------------------------------------------------------------------- -------------------------------------------- Final Ins ectian - � -------------------- - ------ --------------------------------- - ----------------.--- - P Y �'!` -------- ----------------Date ^ -� -- - SAN JOAQUIN LOCAL HEALTH DISTRICT (�� `4115 E. H. 9 1-'68 Rev. 5M