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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------- ------------------------------------- Permit No. ��=--v-�� (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued a-"_f`_7l_.. 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 o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT ONo G G_e.$_ o.-'�0 `V--------J'1;1111� ---_CENSUS TRACT _________________________ Owner's Name ... "°�+ 41, =---------------- Phone / , _`. _ Address .] 0 r------ _Ar4s: —----------------------------------- City ------------------------------------------ Contractor's Name ------ _ `_ r�________________License # S__ Vdj___ Phone ^ Installation will serve: ResidenceN(Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- _ � t Number of living units:-___/__. Number of -bedroom Garb ge Grinder ------------ Lot Size o75 ------------- 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,) Z. '/ PACKAGE TREATMENT [ ] SEPTIC TANK'X DD Size__ _X�__�_�____-_.___.__ Liquid Depth __________________________ Capacity LR®4___-__ Type1L '4_ __ Material.t- lti ------ No. Compartments _____ Distance to nearest: Well ------- cd}�-Q ___________Foundation ------/- Prop. Line ____s • • �V11 LEACHING LINE No, of Lines _ - Length of each line-e" -7V_ __________________ Total Length 49-c/6-____.__-. 'D' Box ------/__ Type Filter Material Depth Filter Material _____ _ _________________�.__......_. Distance to nearest: Well *�2_ --- Foundation _ _Q__ ________ Property Line ____yrs................. SEEPAGE PIT [ ) Depth ____________________ Diameter ________________ Number ---------------------------- Rock filled Yes ❑ No 0 p Water Table Depth ----------------------------Rock Size -------------------------------- Distance to nearest: Well ----- ----------------------------------_Foundation -------------------- Prop. Line ...____.....__.._...._ REPAIRfADDITION(Prev. Sanitation Permit# ____________________________________________ Date _____________.____________________) 7y SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- -------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that l 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 bec a su Iect to W rkm.4n s Compensa` laws of California." Signed - '� -- --- -- �--- / /�-� - Owner BY -------------------------- - fG/. � _ Title -------- ------------- (If other than owner) 7 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------- DATE ------------- BUILDING PERMIT ISSUED //--------------------------- --------------DATE --- ------- - -------- ----- ------------ ADDITIONAL COMMENTS _. -, - fi t -_411---------------------- = - ------------------------------------- - - ---- ------------------ --------------------- ---------------- - ------------ ------------------------------------------- ----------------------------------- - - ------------= f Final Inspection b -------------------------Date ------------- -------------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M