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-'FUR OFFICE USE: -{ ?APPLICATION FOR SANITATION PERMIT .� �C�-f/J-�S Permit No. ---------------------- ------- '_." ----"-- -- �'d' -------�� `=-- ---------- 'i4 (Complete in Triplicate) i. I ill' ------------------ - -------------- Date issued fa"=19y -------------- This Permit Expires 1 Year From Date Issued s t Application is hereby made to the San Joaquin Local Health District for a permit to construct agnd install the work. herein described. This application is made in corn liance with County Ordinance No. 549 and existin Rules and Regulations:0 I ESS/LOCATION- - -- - - - ---� -- JOB AQCNSU ES TRACT --- DR ` ' -..-,:Phone � -. Owners Name --- � , Address ------ ------------- 1 /�4 /__ Phone --------- Contractor ------- Contractor'sName�- " - -'=- - -- """ ----License # .- .__ ---- s Installation will serve:.. Residence Apartment House ❑ Commercial :❑Trailer Court ❑ Motel ❑ Other ---------------------------------------------� Garbo e Grinder_ eI-� � '�-- Lot Sizeo�7 ��-----�----------- Number - ---• Number of living units:_-""t ".__ Number of bedrooms ---- g - , -r Water Supply: Public System and name{- -------------------- --------•-- -------;------ ------- ----- Private 1 f Peat =Sand Loam Clay Loam , Character of soil to a depth of 3 feet: Sand❑,w Silt❑ Gay ❑ ❑ Y ❑ y Hardpan ❑ Adobe 5' Fill Material --------- --- If yes,type ---- ------------------- k (Plot plan,'showing size of lot, location of system.in-relationwtoWei ls;vbuildings, etc. must be placed on reverse side.) NEW INSTALLATION: "{No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Size--------------------------- - ----'Liquid Depth ---------------7- ---- + �+ PACKAGE TREATMENT-{ I SEPTIC TANK'[ ] ° .. m, ' capacityt _ - � -------------- ---¢ No. Compartments -------- 7 pe "-- ""-- -- Materal "-- ----- ` --------------Foundation _- ------ Prop. Line ---- ---- ----- • � - Well --------- --------- - No. of:Lines ------------- .--- -- Total Len ----------------- LEACHING Length of each line" Length ------•--------- Distance. o n LEACHING LINE [ ] D"Box'^--___""-___ .T e� Depth Filter Material ---�--=-•--�::v-._•r --�-•-----�--- --r- �+ Filter Material -_ -" ___"-- ------ p --" Property Line �-� --- -- oundation p rtY W Distance to nearest: Well ---------------" I __ Rock Filled Yes. }No i❑ (` SEEPAGE PIT [ ] --Depth--, - - :"Diameter ------- Number a - � 4 Table Depth -------------------------------------------- ---Rock Size -------------------------------- Water $ ' I Distance to nearest: Well ----------------------------- Foundation -- ----- ---- Prop. Line ---•-----------•------ REPAIRfADDITION(Prev. Sanitation Permit# --------------------------------- - --------- Date --- ---- ----------------) i { �- -� -- Septic Tank (Specify Requirements) ----------------- 4a 1/1 i -,k----------------- Disposal Field (Specify Requirements) --- �- 11-,4 ----------- ------- =------------------------------------------------------------------------- ------------------------- ---------------- ------- 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: "I certify that�iperlormance of the wor or whiLhntbnis permit is issued, I shall not employ any person in such manner as to becom o Word ma Compe ati.on laf Californiia." f �` l Signed -- - ---------- ------ By - -- - --------------- -------- Title -- ------------ --------------- ---- -------------------------------------------- ---------------------------------- - k (If other than owner) FOR PARTMENT USE ONLY -- -- - --- - "'` DATE -------- /1- ------------ - APPLICATION ACCEPTED BY BUILDING,PERMIT ISSUED "--- -- ------------ -- ----------- a� �fl� -. M ^ - ----------- - ADDITIONAL COMENTS .> .--- - _-_ ---- �" - --- - --------- --- a -- Final Inspection by: y r --- - ' "--,.rte(.-�----� - - - - - - "" - "-- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev.-5M. r _ --------------