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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ._7_�-_I__ ____.. 4 Date Issued --- --------------------------------------- ------------------ This Permit Expires 1 Year From Date Issued x 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: ,. JOB ADDRESS/LOCATION ----- ----------- 4�- ---------CENSUS TRACT . f Owner's Name ---------------_ - = Phone l a, E, Address --------------------- ------ City ---- Contractor's Name _.. -------- -------,54-_X_`------.License # ------------------------ Phone ----------------•---_--------- } Installation will serve: Residence Apartment House-E] Commercial :❑Trailer Court i❑ Motel ❑Other ------------------------------ ------------- Number of living units:____ ----- Number of bedrooms _"______Garbage Grinder ------------ Lot Size _________•_______________________________ Water Supply: Public System and name ---------------------- ------------------------------------------------------------------------------•----- ._Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam�f] Hardpan R] Adobe ❑ Fill Material --'------___ If yes, type ----------------------------- (Plot ________________________(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 [.�J Size__ ?'-f-----' ___ Liquid Depth _ '..... AOXCapacity .l _bG ___--- Type ,�tAl— -- Material--- +�--- No. Compartments _ -----•.--..=_. Distance to nearest: Well ___._, __________________________Foundation ------ '------------- Prop. Line _________.._.__..__._ LEACHING LINE fr] No. of Lines _____A_______________ L6ngth of each line-------J'0------------- Total Length _�± ............. 'D' Box _7___. Type Filter Materia) �IF---___.-.Depth Filter Material __I_p__________________ ___ —10 Distance to nearest:Well _ ______________ Foundation /6------------------ Property Line ._S-_---._.---_ SEEPAGE PIT [jyj Depth .__ ---------- Diameter 3 '______ Number -- ------------------------- hock Filled Yes No i❑ Water Table Depth --,?0---------------------------------------Rock Size - •-------- Distance to nearest: Well ___ --------------------------Foundation _ --------- Prop. Line ___.._-__---•__-- REPAIR/ADDITION(Prev. Sanitation Permit# -------_-------------------------_---------- Date ____-_--______-___--______________J y Septic Tank (Specify Requirements) ----------------------------------------------------------- ----------------------•---------------------------- •--------•-- Disposal 'Field (Specify Requirement�ti--------- ------------------------------------------------------------------------------------------ ------ W. , ----------------------------------------------------- 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 t it in perfo ante o he o fo which this permit is issued, I shall not employ any person in such manner as to bec e s to r a 's so laws of California." f Signe ___ ___ Owner BY ------------------------------------ ------------------------------------ ----------- ------------ Title ------------------------------------- ---------------------------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------- ------------------------------- DATE ----------------------- BUILDINGPERMIT ISSUED ---- ----------------------------------------------------------------------------------------------------._DATE ------------------------------------------- ADDITIONAL COMMENTS ------------- ------------------ --------- ---- --------------------------- r --------------------------------------------------------------------------------------------------------------------•--------------- -----------------------------------------------------------•--------- ------------------ -------- - - -------------- ------------------------ Final Inspection by.. ---------- --------------------------------- ------------------------------------Date - 71---------- SAN JOAQUIN LOCAL HEALTH DISTRICT r . E. H. 9 1-'68 Rev. 5M