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FOR OFFICE USE: Y/4 Y/76 APPLICATION FOR SANITATION PERMIT +fir I ----------------------------------------- Permit No. --------------��rJ i (Complete in Triplicate) � ------------------------------------------------------- -. Date Issued -�'��=�' - ---------------_-_-__--__________-_-----------------_ This Permit Expires 1 Year From Date Issued il Application is hereby made to the San Joaquin Local Health bistriet,for a permit to construct and install the work herein .! described. This application is msYY77 erjx� compliance with County Ordinance No. 5.49 and existing Rules and Regulations: i JOB ADDRESS/LOCAT N 1 r`g55 ....... --CENSUS TRACT _________________________ Owner's Name __. -- ----- ---------.Phone -------------------- ------------ d i-------------------------------------------------------- Addressc --------------- --- - - ------- City Contractor's Name l License # J94?:3(f� Phone ------------------------------ Installation will serve- Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other --------------------------------- ---------- Number of living units:----- Number of bedrooms ------ Grinder ------------ Lot Size _________ __________.______________-.--- Water Supply: Public System and name ---------------------- --------------------------------------------- ------Private Character of soil to a depth of 3 feet: Sand0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type -_--__.___.__-_-________- 4 (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 [ 7 SEPTIC TANK Siie ,�atY_,Z../t ��----------------- - Liquid Depth --- --------------.----- Z�E�-- -- T __-- -G� Material-- ----- - - - --- No. Compartments -a------_------ \ � Capacity -� --- ------ Type . Distance to Weare Well _V---------- --------------Foundation --------A-D------- Prop. Line -X___----_-------_ y� LEACHING LINE No. of Lines ----------- Length of each line.......Fa_ ---------- Total Length _-164-------------_ 3 'D' Box _ __._.__ Type Filter Material --___Dep li Filter Materia ___l ( =_ �_.-_-. / i Distance o nearest: Well-2Q__'_ ______ Foundation -____. fir__--------_ Property Line --- % --------- -- SEEPAGE PIT [ ] Depth _--_______________—Diameter ________________ Number __-_______-_.__- Rock Filled Yes ❑ No i❑ I WaterTable Depth --------------------------------------- ----Rock Size -------------------------------- I Distance to nearest: Well .____-________________________________Foundation -------------------- Prop. Line _._-______--_-_-_-_-__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------.-----------------------} } Septic Tank (Specify Requirements) ---------------------------------------- -------------------------------------------------------------------- •------- --------- --------- ; Disposal iField {Specify Requirements) --------------------------------------------------------------------------------------- ------------------- --------------- -/ ---------------- ------------------------------------------------------------------- t ! --------------------`---------------------------------------------------------------------------------------------- (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 Ordindnces�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 i BY ------=--------- - 1--- �✓. �- ---------- Title . (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------- DATE ------ BUILDINGPERMIT ISSUED ----------------------- ---------------------------------------------------------=-- -----------DATE ------- ------- •----------------- ADDITIONALCOMMENTS ----------------------------------=------------------------------------- ------------------------------------------------------------------------- ----------- ----------=------------------------------------ -------------------------------------------------- ----------------- -- ------------ ------------------- -------------------- ---- ---------------------------- ------------------------------------------------ -------------t-- 1-----------•- --------------------------------- ----- --------------- ---- ---- ----------- -- -------- ------------ --------•--- ------ Final Inspection by: Date _ -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E: H. 9 1-'68 Rev. 5M