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FOR OFFICE-USE:- APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No. ._ :. (Complete in Triplicate) ..........I—............................................ --... This Permit Expires t Year From Date Issued Date-Issued ... s 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 ....................CENSUS TRACT .......................... Owner's Name -.��-V )!- f ! -----..._ -. .................... ...:... ............Phone Address ..�Q. _._. ..... _/. /h.+�JrN'1.:.? v_........................•--.-..... City Meet/ !G f-89.... �jjr r. �, Contractor's Name _ L- 7 ./1_-/-_`p-_.__ ....._.License �# '. I..� .... Phone .srJ' ............... Installation will serve: Residence ❑Apartment House JJ Commercial❑Trailer Court f-] Motel ❑Other..._-lC'?-/bi!k4............... Number of living units:__.____ Number of bedrooms Garbage Grinder Lot Size Water Supply: Public System and name _ .......................----- --- ...._.- ............_............•_•....... ...Private s f Character of soil to a depth of 9 feet: Sand o Silt o Clay ❑ Peat❑ Sandy Loam o Clay Loam ❑ Hardpan ❑ Adobe 0 Fill Material ............ If yes,type ............... ............ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 3 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Li PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size..... .........................----------------- Liquid Depth p .......................... Capacity -------------------- Type ---- ............. Material...................... o. Compartments ...................... I Distance to nearest: W4II ............... ............Foundation . ................... Prop. Line ...................... •LEACHING LINE [ ] No. of Lines ---------------------- Leng of each line...------.-._.-. _....__.... Total Length V Box ............ Type Filter Ma rial ....................Depth alter Material ................................ Distance to nearest: Well ---- ------------------ Foundation ........................ Property Line ............... SEEPAGE PIT [ ) Depth -------------------- Dia ter ................ Numbe .............................Rock Filled Yes ❑ No ❑ Water Table Depth --- ------------------ ................. -----Rock Size --...---....._.... ............. Distance to nearest: ell ............................ ...........Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Per .......•---------------------- --- ---- --- Date ------------.-.................... � SepticTank (Specify Requirements) --------------------------------------------......................................:.......................•..--•--........................... Disposal Fiel"Spec-+f equirements) ...... ...... �_....�� 1 .__ _._ :---- ------ . -- A 2 f�._ !�� .---=-----A 1V -------- o_.1..,5- --- ..`....�1�!e.._..��- xx d.....�e�: ... _____ _________ . (Draw existing and required addition on reverse side) I hereby certify that 1 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, 1 shall not employ any person in such manner as to become subject to Workm 's Compensation laws of California." Signed .--- ---- •---- --- - - ------------------•- � Owner --------------- FBy -------- '------ - • ----- - -------------- Title ------_----------- _------------------------_ (If other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ------ ------------------------------------------------------ DATi ... :� . ------------ BUILDING PERMIT ISSUED _.. ._- --------------------------.DATE - ADDITIONAL COMMENTS ------------------------------ ....----- :.... ---------------- - - Final- ----- ---- ---•- ------ _--- ----- .. " - _-. ---•- _.__--- _-. -- Inspection by: _.. , _ ------- ---------------------•-----..---•--'-_-_-.._.------ -• ----- ---. Date ----..--------- --- EH 13 24 1-68 5M SAN JOAQUIN LOCAL. HEALTH DISTRICT 874 3M