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FCS OFFICE USE: i APPLICATION FOR SANITATION PERMIT ---------------------------------- - 7 Z (Complete in Triplicate) Permit No.. _- -_.'_-- ---------I---- ------------------------- -- This Permit Expires 1 Year From Date issued 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/LOCATION ATIt/7------t..._- ---- -------------------- -------{- ---------CEN SUS. TRACT -- _ --•_----.----- Owner's Name + ° ��sjl ----------Phone --3b_-_`-4 / -- Address -------------- City - '`-------------- Contractor's Name - ------- ----------------------------------------=--------License # ------------------------ Phone ------------------- i Installation will serve: Residence ❑Apartment House❑ Commer 'al ❑Trailer Court Motel ]Other _ Number of living units:----!____._ Number of bedrooms _._---Garbage Grinder _.:-------__ Lot Sze ._ - . - ________ Water Supply: Public System andi�name -------------------------------------------- ------------------------ ---------------------------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -K Clay Loam ❑ JHardpan ❑ Adobe-❑ Fill Material ------------ If yes, type ---------------------------- (Pl'ot plan, showing size of lot,�i"location of system in relation to wells, buildings, etc. must be placed on reverse side.) u NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet] " / 11� PACKAGE TREATMENT { I SEPTIC TANK"( Size_-W+a�,X'_._f------- ______ Liquid Depth __- -:_,%,_______________ 1*1% IM /� Capacity No. Compartments ___._¢i .1�___ Type &0!' 4 jtMaterial....I __._ _ "- Distance -to nearest: Well ---- _I!______________________Foundation ... ------------ Prop. Line --- -- v LEACHING LINT: No. of Lines ----2--------------- Length of each line-----�10_.._----------- Total Length ----1.610......._.... 'D' Box '__ ----- Type Filter Material _� ,)--_Allepth Filter Material ---If-____-___._-_. `............. Distance�to nearest: Well ---S-.0------------ Foundation __. ----------- Property Line _Is------------------- SEEPAGE __________ ____SEEPAGE PIT [ ] Depth ----------------- Diameter ---------------- Number ------ --------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance+to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----I................. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ------------`-------------------------------------------------P------------------------------------------------------------------------------ Disposal Field (Specify Requirements] �f k_ - -- - - -------------------------------- ----------------------------------------------------------------------------------------------------------------------- ------------------------- jN {Draw existing and required addition on reverse side} I hereby certify that I have prep 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 performanceMof the work for which this permit is issued, I shelf not employ any person in such manner as to b come b) to W rk �'s,,ComRensation laws of California." Signe _ - �- Owner By --------------------------- - I-------- ------------------- ---------------------- Title ------ ---------- ------ ------------------------------------------- -- - (If other than owner) IM R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------. DATE ------ -----47 7------- BUILDING PERMIT ISSUED -------- 1M------------------------ - --------- ---DATE ------------------------------------------- ADDITIONALCOMMENTS -----------1)------- -------------------------------------------------------------------------------------------- = ------------------------------------------------------ --------- ----------------------------. r Il ---------------------- -------- ---- II ---------------------------------------- Final , Final Inspection by: --- 'M-- 1 ____- - ----------------------------- --------- --------- -- ---- --- ------ - -- - -- Dat.. ... �. SAN JOAQUIN LOCAL HEALTH DISTRICT 1 E. H. 9 1-'68 Rev. 5M �