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FORF,�ICE �E�m APPLICATION FOR SANITATION PERMIT .......... . �.............................. Permit No. .7� ...... (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 lin compliance : Jwith County Ordinance No. 549 and existing Rules and Regulations JOB ADDRESS/LOCA71 . . ...--- ----------- .CENSUS TRACT .. Owner's Name ......... '.... :...... G?tit .... ............ Phone ----...r................... Address ..� `.... f es...... ........•-•--- --......1. City .... . ............................................. � o �..� � .Contractor's Name ........--•-------------- - g------ __-Ph Installation will serve: Residence Apartment-House O Commercial'C]TrailerCourt 0 4l. �. � Mote ❑Other _.._..�---�•----.-------------------------- Number of living units:.... Number of bedrooms _... �g � � �--Garbo a Grinder .-----_-_--- Lot Sixe ... LL?.._�1!r�'e-.•....... Water Supply: Public System and name ................................... rf, � '!,-.......................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 0 Peat C3 Sandy Loam ❑ Clay Loam 0/ "V i ~ i Hardpan ❑ Adobe fl/Fill Material .........%-- If yes,type ------------ --------------- (Plot plan, showing size of lot, location of. system i 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[ ] Size_._....._...�. .........................•----- liquid Depth -_....--__----__-..-_.- Capacity ----------------!4: YYPe _..:..:, Material. No. Compartments ..................... Distance to nearest:/Well ................... o.Foundation- ..._..... ............ Prop. Line ...................... LEACHING.LINE [ J No. of Lines .......... ------------- Length of each line............................ Total Length 'D' Box ......__-....Type Filter Material .... . . .... Depth Filter Material ............................................ Distance to nearest: Well .............. �... Foundation.".`...................--_-•_-- Property Line .......................• SEEPAGE PIT [ ) Depth Diameter Number..;--_____..._. Rock Filled Yes ❑ No Q Water Table Depths '.` I.._.--_•..................... -R ck 5izi;........ ..------............... Foundotionss I Distance to nearest;_Well { Prop. Line ...................... j ------ I REPAIR/ADDITION(Prey. Sanitation'Permit 56s ------------------------------------------'Dote .L..................._..........) Septic Tank (Specify Requirements) ..... + ------..�. . . ........ ...................••----...._...._._..........._-•----------._..- -------------- Disposal Field (Specify Requirements) Y�1 .. I i �� 3" -� ----------------- . ......... -------------- -- ................. ......................................................t....-----------------------••••-r-•-----•------•----•-- (Draw existing and required addition on reverse side) I herebykcertiWthat I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Sicite 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 n of employ any person in such manner as to become subject to Workman's Compensation jaws of California."— # Signed ----------- -------- .......... .................................. Owner By ......... .... .... . . ...... "_........ •-•-•-..........._ xitle ......--- --- (if oth t on.fo�wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ .. DATE .. . . .."._........ ._ ....:.... BUILDING PERMIT ISSUED . .... . ................... --• •---•---•-•-. .. -- : ........ :...:.. D TE ... . . ... . ............. .. .. ADDITIONAL COMMENTS ....... .... .. ...•----.. .......--.—"7�. �..._.. ct'LQ .. .i. D--- --- :-:::��..Q.� :: �v_�. _ _ . .._. � ...............................................................................................................................................Y .-- A. ... .I................... ....... .._........_..................... ............................................................................. .------------ ......... ................. ....................... . ............................................................... Final Inspection b Date .._. ...... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M