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b �- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------- - ----------------- - (Complete in Triplicate) t ----------I------------------ --------------------------- Date Issued ----------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 ---------- ------ ------------------------CENSUS TRACT --------------•----------- Owner's Name ------- ------------- ----------Phone . City __ Address - ----- -- - ----------- -- -------------------------•-•----------••-- h�/------ --- -- ---- rP Contractor's Name --------------- -- ----�' License # Z.0— ./-7.7 Phone _ -- Installation will serve: Residence,&Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ---------------------- ------------------- Number -- --------------Number of living units:-_/__-- Number of bedrooms - _�- _ ------Garbage Grinder ___ Lot Size _. hf� --� ��------------- Water Supply: Public System and name ---------All,.- 1 ------- r ------------------------------------------------------Private ❑ „ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ ` 'AClay .❑ Peat ❑ Sandy Loam ❑ Clay Loom .[:] Hardpan ❑ Adobe'Fill Material --------- -- If yes, type ---------------------------- (PI"ot 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,] 1 '\ PACKAGE TREATMENT [ ] SEPTIC TANKX Size-a----I `__1,�---------------- Liquid Depth ---_- -----_---..___ Capacityla "t Type -d Mafierial_,��e`"_=_"-__y_- No. Compartments -----;2 -------_•--- Foundation -----Z:a�_/------.Prop. Line -------- Distance to nearest: Well ...... - -------------- f Q rA � � LEACHING LINE No. of Lines ---11;7 Length of each line---1 -_---- Total Length _7_17 1 Box --Z----- Type Filter Material __A ----Depth Filter Material ---rf'-fir.--.-------------- ------ rr � f ' Distance to nearest: Well __---��-.---_---_ Foundation _Z61 __ __ ________------ Property Line. ---S-----------•-- .--- f� Number --------c -- Rock Filled Yes Ek No SEEPAGE PIT Depth -2-S----------- Diameter --7-Z-_ - - 110 l Water Table Depth ---------9 -------------------------- Rock Size r, Distance to nearest: Well -.-- Q-G- -----------------Foundation -_ __ __-- Prop. Line ..__ _________-- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------4------±f------ ----- Date --_-------------------------------) " I Septic Tank (Specify Requirements) ----------------- -------------------------------------------------------- - Disposal Field (Specify Requirements) -------.---- - ---------------------------------------.-•--------- t ----------------------- --------------------- - ------------------------------------------------------------------------------------------------ ------- ------------------ ------- -------------------- - - - - ------------------------------------------------- ------------------------ (Draw existing and required addition on reverse si e 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 ,�1wQ = Title -- r� ------------ BY ------------ G� (If other than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = DATE w� - �" 7A---------- ----------------------- BUILDING PERMIT ISSUED --------- DATE -.... COMMENTS ------------ -12f-�'---� _--`� ---------------------------- ADDITIONAL ------------------------------------------------------------------------------------------------------------------------------------ ---- ------------------------------------------------ ------------------------------------- ------------------------------------ - --- Final -3-'---------------------------- 5----- --------------------- -------- ------------ ----- --- ------------ ------------------- -- - --------------------Date Inspection by: = SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M