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F FOR OFFICE USE: ' - I APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: .-_`7._ 'v7 p p -----------------------------------------------• This Permit Expires 1 Year From Date Issued Date Issued ----- _�_t, --7 7, Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein k described. This appfication is Fnade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --J�l�io / �€',r�--------- --------------- --- ---- -----CENSUS TRACT5�----- Owner's Name ! Address .- 5 5 ----- ----- city -------------- ----------------------- sG Contractor's Name __ r` ---,. . J 5, License # 72. ------ Phone -_ Installation will serve: Residence®Apartment House-❑ Commercial : Trailer Court �y Motel ❑ Other / Number of living units:--4/------ Number of bedrooms I___/_____.Garbage Grinder y�-.__- Lot Size _1 Ae/e. t _ Water Supply: Public System and name ___--______________-_a__ t ------------------- --------- e r - --Character of soil to a_depth�of 3.feet: ' Sand' Silt Cia ' y ❑ Peat[- Sandy Loam (] Clay LoamF] _ Hardpan[] Adobe ❑ Fill Material ------------ If Yes, type ._---_.__.__•--------------- a1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (itl NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT '. [ ] SEPTIC TANK Size- �/ . �� "' � --- ---- - - ----------- ---- Liquid Depth -J---- ---- 'n i Capacity� D� L Type11Aaterial U �/.e/ No. Compartments ______-•_______-- Dist ' Distance to nearest: Well ----- ------------------------Foundation ...ec?-r ----------- Prop. Line --=------------�-•-••- i LEACHING LINE [ ) No.' of Lines ___l___--___________ Length of each line-___%-fel-___------- Total Length ---�6 � ' ---------- 'D'i Box _/, 2___ Type Filter Material AVG ___Depth Filter Material ____f 1� � • f ip __----------------- --•---•- [ ] Distance e tante to nearest: Well _____ -___-----_ FoundationProperty Line ___5`____-.__._.__ _. SEEPAGE PIT Depth __.______-_____ -_ Diameter --------- Number _________ Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size •t Distance to nearest: Well ___--__________________ _ __------------Foundation ............... Prop. Line ..______•--_______- REPAIR/ADDITION(Prev. Sa l itation Permit# -------------------------- ------------------ pate ____________.-_____.___ -----•----1 Septic Tank (Specify Requirements) ___------_________._ - -------------------------------------- - isposal Field (Specify Requirements) ----------- --------------- ---------------------------------------------M----- ---- --- (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 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 s Wthan rman's Compensation laws of California." Signed --------- ------ ---- Owner BY ---------- - ---- Title ----------------------------------------- owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... ------------------- ----------------------------------- ----------. DATE --- BUILDING PERMIT ISSUED =i -------- A DITIONA COMM DDITIONAL COMMENT., --------------DATE ---1----�r------�•--�-j----- ---------------------------- -- -- o -._ -- - ---- -------------------- f' ---------------------------------------------------------------------------------------- f --- -------------------- - - --------- -- --- - --------------- ' ctinb _ ------ ----------------------------------------- --------- ------ -------Date ----Fina ------- { -------- $ SAN JOAQUIN LOCAL HEALTH DISTRICT •--- iE .. E. H. 9 1-'68 Rev. 5M 1