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f G FOR OFFICE USE: ' j APPLICATION FOR SANITATION PERMIT ,` -------------- - --------=--------•------- --------- .. Permit No. Jg"7��_. ' r . > a (Complete in Triplicate) "{ f -----------------�1`� ----- r - ' ...S -. � Date Issued ':_- � - _ -------------- _---_---- -. d-- ---_-____ This Permit Expires 1 Year From 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: 5� 7,� JOB ADDRESS/LOCATION J- ----------------- -- ----- --- ----- ---- - ----------------------------.-CENSUS TRACT --------- ---------------- Owner's Name --- 1'�. ------------------Phone ----------------------------------- Address --------- Q----- ----g----(---r City ------------------------------------------------------------------------- Contractor's Namz_ -'�_.,__---S__T5------------------------------------------------------License # 177$I_J Phone Installation will serve: Residence ❑Apartment H use❑ Comme c' I:❑Trailer Court ;[] Motel ❑Other --- -------- ---------- -- -------. . Number of living units:_-------- Number of bedrooms --____-__Garba Grinder,��---- Lot Size -.--t - A-------------- Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------.Private Character of soil to a depth of 3 feet: Sand F1 Silt❑ Clay,0 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'[ ] Siz e------3 -5-"�___ -__-- Liquid Depth _�-r------------------ Capacity -------'C9GType _,!7&o__/arwateria1-�_-- ------ --- o. Compartments ... ............... ] Distance to nearest: Well - - -- -----------------__Foundation �� Pro Line lO - f' p- = \I LEACHING LINE [t4-` Na. of Lines ___/------------------- Length of each line__x��---..----- 9 Total Length `D' Box :�--- Type Filter Material�G� -------Depth Filter Material -/k---�_--_--- ----------------------- �. Distance to nearest: Wellap_ ---- Foundation _7P___ ----------- Property Line SEEPAGE PIT [ Depth ___. - -i- Diameter 33_.Y Number T -----/----------- --------- Rock Filled YesNo i[] Water Table Depth -v Rock Size ¢ Y Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------..-...... REPAIR/ADDITION(Prev. Sanitation Permit°# -------------------------------------------- Date -----------------------------------) SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- --•------------------------_ --------------------.-•---- DisposalField (Specify Requirements) -------------------------------------------------------.-f---------------------------------------------------------------------------- -------------------------------------------------------------------- ----------------- ----------------------------- - ----- -- (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 ownor 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"aim person in such manner as to b;;, eru seject to Workman's Compensation laws of California." f Signed _-T Owner V By ------------ ----- ----- -- --------------------------------------------------------- Title ---a_t,/4c e5 c- t_ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- - -------- - ---0,- ------------------------------------ DATE BUILDING PERMIT ISSUED f----- -------- -------------------------------------,------------------------------ -DATE ------- -----•----------------------------- ADDITlONAL COMMENTS t -------------------- l� J --------------------------------- ---- � --------------------------- - ----- -- - -------------- - ------ Final Inspection by- -------------- Z- -- ------- ------ ---- <---- ------------------------------------------------------------------------------------------- ---- ---------------------------------------------- -----.- ate --..--D -3.:-- -- - --------- SAN JOAQUIN LOCAL HEALTH' DISTRICT ,E. H. 9 1-'68 Rev. 5M