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FOR OFFICE USE: 3-1?---------------------- ----------I APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) This permit Expires 1 Year From Date Issued Permit No. Date Issued _ 3`1----_.. 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-��' C___,____ 5____ Ise _4�Ar�7ee7_.-CENSUS TRACT _____l__ ------------- Owner ___________Owner's Name .--------- —-------------------------------------------------=- ------.Phone ------------------------------------ Address.j/trr'/%��------------------------------------------. City `„?'-------------------------- -- Contractor's Name _ - ------------------------------- --------- License #101f 5?;,f_ Phone iw-+S'ss' Installation will serve: Residence Apartment House ❑Commercial: ❑Trailer Court ;❑ f Motel ❑ Other -------------------------------------------- f Number of living units:_. ------ Number of bedrooms _____Garbage Grindere �G-- Lot Size __________ Water Supply: Public System and name -------------------------------- ----------- --------- Private,' Character of soil to a depth of 3 feet: Sand 'E] Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ 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, f -.,isC__� r Liquid Depth W------------------- Ca aci p tY��l%P------ TYpe�t MateriaiC��------ No. Compartments-�_�-----------------•Distance to nearest: Well_____�f__________________Foundation _'z9 i___-____ Prop. Line ,IAO ----------- � � f LEACHING LINE Yr� s No. of Lines -__— --------------- Length of each line_ -d 7_________._____ Total Length _...........__.. W . '� w 'D' Box V._ Type Filter Materia%_ _ __.Depth Filter Material /____________________________________ y Distance to nearest: Well -A-12 ----------- Foundation _o2,____________ Property Line _._01V_1 --------- SEEPAGE PIT (j(] Depth --a;7.4 ----- Diameter s.��f--__ Numbe, ------ ----------- Rock Filled Yes ' No i❑ rn F ✓ ' � %!� it Water Table Depth '-------------------- ------------ Rock Size =�-�-------------- -.1 ----------- �. Distance to nearest: Well _ �------------------------ Foundation l am_____ Prop. Line-�.------------ REPAIR./ADDITION {Prev. Sanitation Permit =#-------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements)-------------------------------------------------------------------------- ----------------------------------•----------------------------- DisposalField (Specify Requirements)----------------------------------------------------------------------------------'--------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- t ----------------------------------------- ----- - - - - -- --------------------------------------------------------------------------- (Drawexisting 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 become subject to Workman's Compensation laws of California." Signed ---------------------- ----- Owner BY ----------------------------- Title -------- ---------------------- -------------------------- {If oche an owner]) F PARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ------------------------------------------------ ------- DATE------3---`-Z---------------- BUILDING PERMIT ISSUED ------- l - -- ----------------------------------------------------- --------DATE ---------------------------- ------- -- --- ADDITIONAL COMMEN -- --- --------------------- r ' ---------- - f -- - - - - - - - - - - - - - - - - - - - - - - - -- -- --------- - - - - -- ----------------------------------- - - - - ----------------------------------------------------------------------------------------------------------- - - - - -- - -------------=------- FinalInspection by: ------ ------------------------------------------------------------------------------.Date-----?ilr` ' � JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M