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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - 70- ------ ------------- ------- --•a (Complete in Triplicate) Permit No: - 4---- __ l�o ---------= ---------- ------ Date Issued --- ------- 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 ith Cou ty Ordinance No. 549 and existing Rules and Regulations: - - - CENSUS TRACT --------------------------JOB ADDRESS/LOCATION ( 7= --C � %_ -l ��=----- ------_ Phone ;"Owner's. Name ---------------- -- Address ------�K_Za7l------C.,2 ---------------- ------------------------------ Contractor's NameQ- a License Phone .Cly F t Installation will serve: Residence *<Partment House,❑ Commercial ❑Trailer Court i❑ r + Motel ❑Other ------------------------------ ------------ - - Number of living units:._... Number of bedroomst,-Y------Garbage Grinder*0.._ Lot Size __A'f _ _ ______________ 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 available within 200 feet,) J0 0o F PACKAGE TREATMENT f ] SEPTIC TANK SizeY1X94__K _'1____________________ Liquid Depth - ---- Capacity -------- s��i ______ Type __ MaterialNo. Compartments ---__ _ __ '9------ Distance to nearest: Well ---- ------------ -------------Foundation p--------------Prop. Line _ :--_____ LEACHING LINE No. of Lines Length of each line--Fur Total Length /Zor_,10,_______ 'D' Box-- - Type Filter Material Ito4 ip ♦♦ De th Filter Material / _________.__ + Distance to nearest: Well 'e"Ve -_-------- Foundation v�47_�_________ Property Line. �` � sr p SEEPAGE PIT. Depth _ _________ Diameter v_211%72 Number .---------------------- Rock Filled Yes, No i❑ ! Lc <? r ! Water Table Depth ------ -405�%l -------------=----=--------Rock-Size -------------- Distance -------- --- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION{Prev. Sanitation Permit#'________--_-------------------------------- Date ---------------------------------- Septic ______-_________________________Septic Tank (Specify Requirements) --------- --------------------------------------------------------------------------------------------------------------- --------------- k Disposal Field (Specify Requirements) - --='------------------------------------------------------------------- -------------------•--------------- � I `-* ------------------------------- --------------'__.----- I ----------------------------------------------------=----------------_- . -------------------------..-----:-------------------------------------------------------------------- (Draw ez ting and required addition on reverse side) I I hereby certify that I have prepared thisr apllication and that the work will be done in accordance with Son Joaquin I County Ordinances, State Laws, and Rules and;Regulations of the San Joaquin Local Health District. Home owner or liven- sed agents signature certifies the following: ) L-- "I certify that in the performance of the work f4r'Whikh this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensafi.on laws of California." I Signed ------- ----_ Owner `e N si i BY ; ---- ------- -Title ------ ♦ -_ --- ---- ----- --------------------- {#1 other than owner). EPAR7MENT USE ONLY . r 'APPLICATION ACCEPTED BY == _ -------------# DATE ----- ---------------- i5. BUILDING PERMIT ISSUED. ------ - --- ---------------------------DATE`-- ---------------------------------------- ADDITIONAL COMMENTS �------ - - ----------- ' ---------------=-----=--------------------------- I ; -- } t - ------------------------------ r � Final Inspection by: - ---- SAN ) JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M