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OR OFFICE USE: 7=1,0 -ff�� -' APPLICATION FOR SANITATION PERMIT 4 -- --5:,77- "3_d- Permit No. --------------------- (Complete -5 -(Completein Triplicate Date Issued _16: - ---------------_----------------------------------------- This Permit Expires I 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: Q - CENSUS TRACT ------- ------ Owner's ADDRESS/LOCATION .----1I--�-�-----------..r�-Q-- - -&,04u- -- ------- E, f Owner's Name ------- --------> — --------------------------------- ------------------- -------------------Phone _ Address ----------- a ---- ------ ------------------------- - ` _Gt Contractor's Phone Installation will serve: �'Resi— ,4pzr�ment House F1c Commercial ailer Court Motel ❑ Other -------------------------------------------- Number ------------------------------------------Number of living units:________ Number of bedrooms ______Garbage Grinder ____________ Lot Size --- -------------- Water Supply: Public System and name __ _�_�_ _��-�'------ a -------------------------------PrivateEl Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Locim ❑ Clay Loam ❑ �. Hardpan ❑ Adobe jK Fill Material ____________ If yes, type ____________-____________ 3 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: A (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} • y PACKAGE TREATMENT [ 'SEPTIC TANK f ] Size____ , C S�_-Y_____` ------------ _ Liquid Depth ___: /_________,____ yp ,r _rdAe Material_ _ _ __ No. Compartments " Capacity _�(��Q� T e _ ----2-------------• � -- ter- r Distance to nearest: Well --------_'�"��-------------------Foundation ______�__0___._ __ Prop. Line __ _______----------- LEACH ING __________LEACHING LINE [ j No. of Lines ___,I__________________ Length of each line��--------7_Q___r------ Total Length __7� --------- 'D' Box S Type Filter Material$_ /____j epfh Filter Material _-- _0//__________ ________________ Distance to nearest: Well ----- �`_________ Foundation _.___A0___r----- Property Line ___ -r_....._. SEEPAGE PIT [ } Depth Diameter _________________ Number _.------ -------------------- Rock Filled Yes ❑ No i❑ t Water Table Depth _____________ --- - -=-' - -------------- -----Rock Size -------------------------- Distance ------------------- ----Distance to nearest: Well --------------119 ____________________ Prop. Line __________.._-_____-_. REPAIR/ADDITION(Prev. Sanitation Permit# ___1J1_4�3--------------------- Date ----_--_/!4�o______._) Septic Tank (Specify Requirements)'______ � -____ Disposal Field (Specify Requirements) __,t`li __ _e�_cm_____ __ __L- -------------------- --- �'_ -0c. '__,/L1-n®________ r � oa ------ -- --- - ----- (Draw -f(Draw existing and required addition on reverse side) I hereby certify that`I have prepared this application and that the work will be done in.accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: r "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become sub' t to Worki 's Compensatiton laws of California." Signed ------_. Owner . -------------------------------------- Y --- --- -�---,=.-- - - e erl � � -- FOR'DEPARTMENT USE ONLY r�-------- --- ------- ---- ---- DATE BUILDINGIOPERM TC ISSUED$----------- -�-�-- ----��C--• --- --�'-------------------------------------------------------DATE ------------------------------- ----------- ADDITIONALCOMMENTS - --------------=-------------------==--------------------------------------------=------------------------------------------------ --------------------------- -----------------------------------------------------------------------------=---------------------------------------------- ---=---------------------------------------------------------------- ------ ----------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------•----------- ------ ------ ------------------------ ---- _ ------------------------------ ------------------------ --------- - Final Inspection by. _ ------- ------------------------------ ------------------------ - -----Date _,_ . 1 __ �' --------------- 7 -_ -• SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M