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FOR oFl=1cE U : APPLICATION FOR SANITATION PERMIT q --- ----------------- --------------- - --------- Permit No: -.7)-4F ` (Complete in Triplicate) --------------------- ----------------------------------- bate 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 complian a with County Ordinance No. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCA !-- --` -j -,----- - CENSUS TRACT + Owner's Na. a ------ Phone --- ----- Address ----- _ City 1s�- fx {; Contractor's Name --- --- License # --- �d"-j-phone ------------------------------ Installation will serve: Residence Apartment House f] Commercial :❑Trailer Court i❑ Motel F-1 Other ---------------- --------------------------- Number of living units:__._ ----- Number of bedrooms -„3____.Garbage Grinder ------------- Lot Size ___f�� -- �----- Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private Character of soil to a,depth of 3 feet: Sand'❑ Silt Clay F] Peat E] Sandy Loam Clay Loam ❑W iHardpan E 4 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 [ ] SEPT C TANK `Size_ __ --- Liquid Depth __1______________________ iL v Capacity O N - Typ _ Material_- _ __._ No. Compartments ...... -:---. --- ------- Distance to near st: Well ---- - _---•__-____ Foundation _. __- Prop. Line ---• 57 4F LEACHING LINE [ No. of Lines _____r _____________ Length of each line-_____ __�_-- -_-__- Total Length�,_.____��-��__�_ D' Box --- ------ Type Filter Material --- -5-_ ----- Depth Filter„Mateirial ----/_4-+;--•-------- './...... =---- Distance to nearest: Well `� -___�______ Foundation --- �__.______. __ Property-Line --------------------- - SEEPAGE PIT [°"] � Depth - -__.___________ Diameter _______________ Number --�_-- Rock Filled Yes ❑ No SCJ Water Table Depth ----------------------------------- -------------Rock Size ---------------------------------- Distance -----------------------=-----:Distance to nearest: Well --------------------------------_______Foundation -------------------- Prop. Line;�..............------- , yf REPAIR/ADDITION(Prev. Sanitation Permit# ______- �- - w- :_;-- Date __________________________________1 S Septic Tank (Specify Requirements) -------------•-----------------------` ----- i-----------kI ---------------------------------------------------------- ------------- Disposal Field {Specify Requirements) --------------------------------------------------------- ------------------------------------------------------------•--------------- c%d " ------------------- f' (Draw existing and required addition on reverse side) I hereby certify-that.11 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 became subject to Workm 's ompensati.o ws of California.” Signed - -- --- ------------ ------------ ----------------------- - - --- - ------- Owner BY ------------- --------------- ----------- -- i itle _ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------------------------------------- DATE --..rPt `-- --72---------- BUILDING PERMIT ISSUED - - -------------------------------------------------------------- ----------------------------------DATE - ----------------------------------------- ADDITIONALCOMMENTS --------------------------------- ------------------------- ----------------------------------------------------------------------=---------------•----------- -------------------------------------------------------------------- ---------------------------------------------------------------------- ------------------------------------------------------------ --------------- --------- -------------- - -------------------------------------------- - - ---------------------- -------------------- ----------------------------- --------------------------------------- - -------- - - ---- --- ----------------------------------------------------------------------------------- -- - Final Inspection by: -- --- - ----- - ----------.Date -----? SAN JOAQUIN LOCAL HEALTH DISTRICT W E. H. 9 1-'68 Rev. 5M