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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -6-17 ��- -- --------------------------------I-------------------- [Complete in Triplicate) ----------------------------- ---` _-------- Dote Issued --�-- �� 6 is Per res 1 Year From Date issued it 02 00 Applicoti n ode to a San oa in L ca Health District for a permit to construct and install the work herein i described. This application is made in co pliion�cee with County Ordinance No. 5496and existing Rules and Regulations: J08 ADDRESS/LOCATION - ----- /,J� '._- __CENSUS TRA T ---'---------------------- �,�S A -- --- ----- - - ----- -- _-Phone -------_-------------- Owners Name t�- ' ------------------- Address ------- ° a^1. -------- -- __. City- ---- -- -- -- - -- - ---------------------------•------_.------ 4 Contractor's Name Cd-' `�' -e�D�-•H- License # J�8.3 Phone Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court-El Motel ❑ Other ------------- ' Number of living units:---------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -------------------------------- --- [ Water Supply: Public System and name ----------------------------------------------- ------------ ----------- ------------- ----------------------Private - Character of soil to a depth of 3 feet: Sand'[- /1.1 ❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam 0 Hardpan dobe ❑ 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,) 6\ PACKAGE TREATMENT [ I SEPTIC TANK'( I Size------------------------------------------------ Liquid Depth -------------------------- Ca acit Type -------------------- Material- --------------------- No. Compartments ------.---------.----- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE [ No. of Lines --------------- -------- Length of each line---------------------------- Total Length ----------_--------------•-- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------------------------------------•- . Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ----------------- ...... SEEPAGE PIT Depth _ Diameter ________________ Number ----------.----------------- Rock Filled Yes ❑ No i❑ Water Table Depth --------------------Rock Size ---------------- --------------- Distance to nearest: Well --------------------------- -_Foundation -------------------- Prop. Line _ ............ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 Septic Tank (Specify Requirements) -------------------------------- ---.-------------------------------------------------------- --- �---------••-- Disposal Field (Specify Requirements)F___�--G --- --- ----------- 3' X3-------------------- ------------------------------- ------------------------------ -- - - --- -----------------------------=------------------------------------------------ (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 sub' to Workman's Compensation laws of California." Signed --------------- - - Owner n ------- [% Ti#le - - - -------- ,--W- ------By - ------- --- --- °---- ---- ....... (If other than owner) JOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = ------------- DATE _ .`_ L'-- .�� . -- -- ----- -- - - BUILDINGPERMIT ISSUED -------------------------------------------------------------------------------------------------- DATE ? ADDITIONAL COMMENTS ------------- ----- - ------------------------------------------ ------------ ----- ---------------------------------------------------------------------------------------------------- - --------------------------------------- ----- --- - ----------------------- ---- r Final Inspection by: Date ____ �' -�------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M