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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT //ff�f�/ ------------- - ------------- --------------- Permit No./7/L/�_�-_ (Complete in Triplicate) ¢2/I �� --------------------------------------------------------- This Permit Expires-3 Year from Date Issued Date Issued _ _..__ ------ &p',)', _.-__&p',)', 0e -/en -Y2- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe Thisapplication i made in compliance with County Ordinance No. 549 and existing Rules and Regulations: V4 I 644XAI-4��ire- JOS ADDRESS/LOCATION _'7it�` � �t - +�. _ _. �.► s 4UACT Owner's Name _= u. ,.:a� aG _ .• _ ----- --- -- ---------Phone ------------------------------------ Address .----------- -X�r �� - --------. City f' --- Contractor's Name .--- qcAlpartment -- ---- ---- E------.License #/1,�-- - Phone ------------------------------ Installation will serve:' + ResidHouse❑ Commercial ❑Trailer Court i❑ 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'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 4 � Hardpan ❑ 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 seepa pit permitted if public sewer is available within 200 feet,) Ci PACKAGE TREATMENT SEPTIC TANK Siz / �� [ 1 [ � .�=/---- -- Liquid Depth r Capacity�bQ_ Type ___.___-____ Material_ <�' -__ No. Compartments _ ______________ Distance to neo st: Well ..------S�----_-- _----------Foundation -------t--a___`_------ Prop. Line -----5_f- ------- i LEACHING LINT: No. of Lines ------- Length of each line--------J-04 Total Length _,zPA_U_..... _.._. r� 'D' Box ..__ -.---- Type Filter Material ______________Depth Filter Material ___f_f__________________________________ r I 6 Distance nearest: Well __.__.�__________ Foundation --------l-P----------- Property Line -_�.__-__ S-/ SEEPAGE PIT [ Depth -----� ___ Diameter ---------3____ Number -------cZ--_-_-______ Rock Fi':ed Yes o 11 gQ Water Table Depth -------- 0_ Ar--------------•------------Rock Size ---1--��---'C�------------ Distance to nearest: Well ________ _ _ __ ____________________Foundation ------ Prop. Line _�r._--.__._______ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------.-------------------) SepticTank (Specify Requirements) -------------------------------------------------------------- ------------------ ----------------------------.------------------------•---- f DisposalField (Specify Requirements) ---------------------------- -------------------------------------------------------------------------------------------------------- -- --------------- -- --- ---- - -------------------------------------- ---------------------------------------------------------- ---------- ----------------------------- (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 subject to Workman's Compensation laws of California." Signed --- --- --- -------------------- 6z� Owner, By ----- -------- ------------------------- --- `---t-------- title "tP------------------------------------------------ a {if other than owner) !! _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------ ----------------- DATE -.v �+�.'_ _�_-.--------------- - ---------- - --------------- BUILDINGPERMIT ISSUED -------------------------------------------------------------------------- ------------------- -- ---...DATE -------------•----------------------------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------- ----------------- ---- ----------------•--- -------------- ------------ --- --- --------------- ----------------------------------- ----------------------------------------- ---------------------------------------:----------------------- ----------------------------------------------- --------------------------------------------------- ---------t_- ------ ---------•--------------------------- ----------------------------- -------------------------------------------------------- ------------------------------------------------------ - - ----- Final Inspection by: - -- ------------------------ ---------------------------- Date- 4___ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.