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FOR O'rFICE USE: APPLICATION FOR,55ANITATION PERMIT —�-/ --------------------------I--- -------------- Permit No. .�T-:_'S�----9 (Complete in Triplicate) - - -------------------------------------------- 4 _-_______________ 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 with County Ordinance No. 549 and existing Rules and Regulations: jJ / - JOB ADDRESS/LOCATION _/__ / -- Lt✓ --- - - - --- /..- ---------------CENSUS TRACT --------------------•-.... Owner's Name --- 'fid- ----------------------------------------- ------.Phone ------------------------------------ Address -------- ------------------------------ = --------------I— City ----- --------------------------------------------------g--- --------------- Contractor's Name ------ ---- -----------------------------License # ------- Phone ` - - f Installation will serve. Residence ❑ Apartment ouse,❑ Commercial ❑Trailer Court ;❑ Motel Other -- Y-,'-Garbage w/e r Number of living units--------- Number of bedrooms ------ Grinder ------------ Lot Size 1r7ct>,�$----------------- Water _ ____________Water Supply: Public System and name ----------------------•----------------------------------------------------------------------------------------------------------------------------- 'P ivate� Character of soil to a depth of 3 feet: Sand'❑ Silt 1:1 Clay El Peat E] Sandy Loam'--E] 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 is available within 200 feet,) PACKAGE TREATMENT SEPTIC`TANK: Size----------------------------------j- -- - ---- Liquid Depth -------------- --------- Capacity _/- _____ Type (/- __��}_Material - YP - ----- No. .................:.... � Distance to nearest: Well 75-il4_----------------Foundatio _/% ------ Prop. Line xvX, LEACHING LINE No, of Lines _.____ _________ .Length of a ch line_ __ __ _ Total length _ 'D' Box .__l------- Type Filter Materia _ ___ _C __ epth Filter Material __ : -_ r X Distance to nearest: Well ----� ------- Fou dation __� _ __ ___________ Property Line __ _____-_..-. � _____________ Rock Filled Yes No ❑ O r�..�".. SEEPAGE PIT �Depth ______ �_ Diameter __��_ ____ Number _.__-_____. I Water Table Depth --------- --- ----.._Rock Size --- ---- v ----- -- Distance to nearest: Well ____/ _______________________Foundation Prop. line ___ ....... eb REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ______________.___..__---_________I 3 SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ------------------------------ •-------- Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------------------- -------------------------------------- r ---------------------------------------------------------------------------------------- ---------------------------------- - - -----------------;--- --------------------------------- ----------------------------------------=------------------------------------------ --------------------------------------------------- (Draw existing and required addition on reverse side) - -1 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 Mules 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 subje o orkmar ' Ca-mpensation laws of California." Signed `k {/ . --- Owner. By ------------------------------------ --------------- Title ..-- ------------------- (If other than owner) FOR .DEPARTMENT-USE ONLY F APPLICATION ACCEPTED BY.---------- ------------- DATE ----- -- ---- ------------ BUILDING PERMIT-:.ISSUED ----DATE ------ ------------ --------- ----- t ADDITIONAL COMMENTS _ -------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- ----------------------- ------------------------------------------------------- --------------------- --- - - ------al Inspection by: to SAN JOAQUIN LOCAL HEALTH DISTRICT . . E. H:R9 1-'68 Rev. 5M FAY