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FOR OFFICE USE: ' a t_ , APPLICATION F6R SANITATION PERMIT `-- - Permit No. -- ---------- (Compr"ete 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 in compliance "Countyrdinance 54499,_andd existing Rulesand Regulations: JOB ADDRESS/LOCATIQ-D- _ --' -- - -'�/--------CENSUS TRACT --------------•--•-------- t Owner's Name -- -o----- --- ---------------------------------- -------------Phone --- Address ------------------------ --------- -- - ----- -- City --- -------- -----------------------------------/---�------- - Contractor's Name --___-- __-- -- ------------------ --------Lice se: /dI�--- Phone _!WA' �i!r!.___ Installation will serve: Residence XApartment House❑ Commercial-' railer Court l❑ Motel F-1 Other ___________ --------------------- Number ____ __________ f] Number of living units:---- ------ Number of bedrooms ____Garbage Grinder ------------ Lot Size _.__ __f7 _Lrl�-____---_____ ' Water Supply: Public System and name ------------------------------------------------------------------•-------------------------------- -----•-----Private ❑ t Character of soil to a depth of 3 feet: Sand❑ Silt[] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .0 Hardpan-❑Adobe Nt—Fill Material*---�If yes;type ------ ----- __________-__ 000.,r I . I t I [Plot plan, showing size of lot, location of system in relation ti°i wells, buildings, .etc. must be placed on reverse side.] NEW INSTALLATION: (No septic tank or age rmitted if public seker',is.available within 200 feet,) 1 11 PACKAGE TREATMENT* [ ] SEPTIC TANK �.'tSize____-___t4_______-"--------------------------- Liquid Depth ______________-___,__ _ ... , pacity ------ ------------- Type ----- _.'------=Material--------------------- No. Compartments ------------------ co, i ce to nearest:- Well ""_''___________- _________ _.F.oundation _.____._.______--_- Prop. Line _____----------------- / ______ ____ _ LEACHING LINE 4�if Lines ------------------------ Length of each -lin ______.______-____- ---- Total Length'100........................ 'D' Box ____-------- Type Filter Material " ______ bepth Filter Material --------- _______�*----------- I --__._______ Distance to nearest: Well ________________________ Foundation--------.___--_______ Property, LineT___�_-_.______._.___ SEEPAGE PIT [ ] Depth -------------------- Diameter ________-_____ Number ___-________ Rock Filled 'Yes 0 No i❑ Water Table Depth ------------------------------------------------Rock Size ------- - ---- ---------------- Distance to nearest: Wel! ----------------------- ---- ------Foundation ------_------ ------ Prop. Line --.------------------- ``"+t , REPAIR/ADDITION(Prev. Sanitation Permit# ...#__________________________________ __ Date _--__________.______.____________} t Septic Tank {Specify Requirements) --------------------- --•- - ,..' ------------- tf I ' � Disposal Field (Specify Requirements) _-__ ______ _____ _ - ---,�..._ -------4D_____� ___Gli4-��_-_ C. 14 C ,_, ( A -------------- ------- ----------- ------------- ----------------------------------------- ----- "'-- ---------- --- --------------------- ------------------------------------ --------------- ------------- --------:---- {Draw existing and required addition on reverse side) 4, 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- ,.t "I certify i in the perForman of th ork for which thiepermit is issued, I shall not employ any person in such manner G, as to beco subleT Work n's a tion laws of California." Signed„" �- ---------- -- -- ----------- By ------------- - --- ----------- ------ -Title {if other than owner) a O PARTMENT USE ONLY I APPLICATION ACCEPTED BY ----- -------------------------------------------------------- DATE •------------------- BUILDING PERMIT ISSUED -------- -- --• DATE ------------------------------------------- ADDITIONAL -------------------------- - --- ADDITIONALCOMME ---- --- - ----- - --------- ------------------------------------------------------- --------------------------=-------------------------,. ------------------------------------------------ -------------------------------------------------------- ------- ------------ - - ---- -- - --- -- - - -------------- -------------- ---------------------------------------------------------------------------------- ------•------- Final Inspection by: ------ ---- -- -------- Date �'�f {` SAN JOAQUIIv LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M