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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------------ P P �_c��s i (Complete in Triplicate) Permit No: - - ----------- i -- -- --- ------ ---------- ----------------- 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 with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ON :. ; ---- ----- CENSUS TRACT -------------- ----------- Owner's Name --- ,rt1�. .................................. ------------ ------Phone -- ----------- P Address ------____-______ w O — ' �� city �"-�-------------------- Contractor's Name = ► Phone 3�! _` -�------ License # Installation will serve: Residence Z1 Apartment House❑ Commercial :❑Trailer Court ',❑ r 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'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam[] y Hardpan (Adobe ❑ Fill Material -- If yes, type ---------------------------- y; (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,J I F PACKAGE TREATMENT SEPTIC TANKf I Size-- --, J -+� X c1 � S � - - Liquid Depth - Capacity __I_100_-,__ Type MaterialNo. Compartments Distance to nearest: Well ____________ D Foundation �� Line Prop. LEACHING LINE [ No. of Lines -_---_._ __.___- Length of each .line------ -(?4_______ ____ Total Length - 2-jP---__..__..-_ D' Box ____- ___ Type Filter Material _---.,��_ -__,Depth Filter Material _-_`_ ------------------------------- d Distance to nearest: Well47o............ Foundation .___-1-0 1-0-0--------- Property Line. _ _----------------- SEEPAGE -----_ _. . _-SEEPAGE PIT /"'�De-pth 2_X-------- Diameter -3. -__--__ Number -------7-------------- Rock idled Yes ff-,"No 0 f Water Table Depth S�6 ---- Water Size 3 --- -( ----------- 6 .,,Distance to nearest: Well ------------10 -------------------Foundation ..-- Prop. Line _-_- -__-_-_- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- -- Date -----------------------------------Y I r � q , Septic Tank (Specify Requirements) -------------------- ---------- -------------------------------------------------- ` --•------- --------------------- Disposal Field (Specify Requirements) ----------------------------------------------'----------------------------------------`-------------------------- ------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------i-------------------=_------------------------ S ---------------------- --__-_--__________,______._.______-_-_,__-_-----_---- f ! . (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 in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to becLesubiect to Workman's'Compensation`laws'of'Colifornia."Signed -------- Owner ------- ---------------------------------------- -- BY Title 44e-It-1 '---------- ---------- U -- -- - -------------- (If other than o ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- �/. :z `----------------------------------------------- ----------- DATE `f Q !4-p------------------ BUILDING PERMIT ISSUED -------------------------- - --------------------DATE ---- -- -------------- ADDITIONAL COMMENTS ------------------------------------------------------------------------------------------------------------------------ -------` - � 9 -__ -----------------------------------------------------------------------------__-_--_--.__________-_-__---______-----_-._----.---_.___------_-----_--__-------- --- - ------- ------------------------- p---------------------------s4_------------------.------------------------------------------------------------- - Final Inspection by� --- --------- ----- ------ -------------------------------------- Date .c.- 7-.. --- SAN .JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M