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FOR OFFICE USE: l 4"I � APPLICATIOI�FOR SANITATION PERMIT -: --------- -------------- rr -------------------------------------- (Complete in Triplicate} Permit No. ._7�--�d- .. Date Issued ----------------------------------------- This Permit Expires 1 Year From Date.Issued F Application is hereby made-to the San Joaquin Local HealtWbistrict for a per 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 .jr3 CENSUS TRACT p Owner's Name - ---------------------------- -=------ ----Phone ----------------------------------- Address ... ----------- ---------- ----------- ------------ -- --. City �r--------------------- 2�J/- ----------------•- _-- Contractor's Name _�.�t-__-_-_- ___-____-_.License # 1' - Phone Installation will serve: Residenc(2;:?Apartment House❑ Commercial :❑Trailet Court ;❑ Motel ❑ Other --------------------------------------- Number of living units:---'/_--_ Number of bedrooms ______Garbage Grinder : Lot Size ------ c Water Supply: Public System and name --- --- ------------------------------------------------------ --------------------------------•-------•-Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay.0 Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 0 Adobes 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 TANK44 Size___ e- Liquid Depth `:_' ------- _____________ Capacity _1,?'Vq .Type -.;p . � -- 'Material No. Compartments " . -------- 6% Distance to nearest: WelI -------------------------- ____ ___________________Foundation -----l4__r______ Prop. Line LEACHING LINE ,�Q No. of Lines -,' _-_�---------Length-of eachline----- ----------- Total Length .___,l U-�____________ _ C 'D' Box;A/62 Type Filter Material _ Q C,Depth Filter � Material __� ----__--_-----�_____-::__-- Distance to nearest: Well -------- Foundation -14---------------- Property Line SEEPAGE PIT _ Rock Filled Yes No �`` Depth _LX_-��__� "Diameter ..Number'Number _____-;�________________ � 0 r i 40 Water Table Depth __- r ----=------------------ -------Rock Size /-�1---------------- ` Distance to nearest: Well __Age2 ---�____________________Foundation _le__'________ Prop. Line . _._-__-___.-__ REPAIR/ADDITION(Prev. Sanitation Permit# - '-------'------------------------------- Date -------:--------------------------] SepticTank (Specify Requirements) --------------------------- ---------- --------------+-------------------•-----=--------------------------------------------------- Disposal -- --------------------------Disposal Field (Specify Requirements) =------7---------------------------------------------------------------------------------------------------------------------- - i� i ----- -----=-------------=------------------------------------------------------------------ ----'-------------------`---- --- ---------- (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: C s "1 certify that in the performan ofVororthis permitis'issued, 1 shall not employ any person in such manner as to become subject to Wor n's of California." Signed -------------- ------------ - Owner BY -------- ----- ------ ----------------- Title ----------- :-------------------------------------------------------- ' (If other Wo ow ) �OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � - V = DATE -------------- BUILDING PERMIT ISSUED --------------------------- -------DATE -----------------_-_-_--- _. . ----------------------------- --------------- ADDITIONALCOMMENTS ------- -------------------------------------------------------------- ---------------------------------- --------------=--------------------------- ------------------------------------------------------------------------------------------------------ --------------------------------------------------------- ., ------------4 _ _ _ __________ _____ _ _ -- '' L _ __________________-_______-___ 111 Final Inspection bY: -------- -------.Date --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. C'