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FOR OFFICE USE- 719 Permit No: -34 APPLICATION FOR SANITATION PERMIT —7 ----- ----------------- (Complete in Tr'sp icate Date Issued --- ---------------- __- This Permit Expires I Year From 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 de in compliance with County Ordinance No. 549 an existing Rules and Regulations: /J 'r �, � o-,- ------------------ JOB ADDRESS/L --� r CENSUS TRACT -------------- ----------- n --Phone T. 1/' , l ._ Owner's Name ' "'+ ----- - tr - = --------------------- Address __..-- lo -------- r City �D Contractor's Nam __-- -_-_.-- ----.License # L___--- Phone - ----- --------- Installation will serve: Residence2Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ----------- Number of living units:_._I------- Number of bedrooms _-Z:+_Garbage Grinder --- -------- Lot Size --C-r- ------------ - _____ Water Supply: Public System and name -------------------------- -------------------------------------------------------------------- -- Private' Peat Sand Loam Cla Loam Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ Y ❑ Y 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.} �J NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is av ilable within 200 feet,) f� PACKAGE TREATMENT f ] SEPTIC TANK ize_ --, - -- Liquid Depth ...... ---- �t ___ e No. Compartments• ___l"_'--------- Capacity Q T YP A ___ Material -ice` ,,► ,.. ,�. S"-�.---- Prop. Line=-f - -- Distance to nearest: Well Qb._r�_--__ _ Foundation ____ '�_J� . LEACHING LINE No. of Lines ---- j_.______________ Lengthto each[line j '` —�,;_�9=-__.Notal Le`ngpth��_��_.`__ r Depth Filter Material ___!__A__:--'--------- - 'D' Box Type Filter Material - � - Distance to nearest: Well - ------ Foundation _ _s _____,_.- Property Line. ____ _.--_____ SEEPAGE PIT Depth ---------- Dia/meter _ .3. � Number ____ ---------- -- #tock filled Yes Na Water Table Depth -----&---/- ----- --- --------Rock Size ---°�---� ----- ---------- - - I Distance to nearest: Well __ _ "© _------ Foundation _________ -_'-Prop: Line ____ -�_-�'- REPAIR/ADDITION(Prev. Sanitation Permit-#=:a-------------- ----- - - Date -------.-------------------------} } Septic Tank (Specify Requirements) ''b' - I ------------------.=---- --------------,--------------------------- -1 F Field (Specify Requirements),`,_-r ------- - 3 ' t --------------- ----------------------------------------- Disposal „�. t - I 1 Draw existin and re uirEd a. ' g q addition on reverse side) I hereby certify that I have prepared this application and k1tat.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: t "I certify th i the performan of the work for hick this permit is issued, I shall not employ any person in such manner as to beco a ubjejt Wor an's Co ens�atio laws of California." Signed -. -- ----- - ---- ---- - ------------ By --------- •+' _ Title - - ------- -- -- - ------ ---------------- -------- ----------------------------------------------------- - (if other than owner) t EPARTMENT USE ONLY t. APPLICATIONACCEPTED BY ------ - ----- --- --- - ------ ---------------------------------- ----------------- DATE -.7 - ------------- ---- BUILDING PERMIT ISSUED --------- -------------- ---------------- -- ----------DATE ------------------------------- --------- F fADDITIONAL COMMENTS -- ---- - ------------------------------------------------------------- --------------------- --- -------- ------------------ i --------------------------------------------- -- ------- - ---------------------- -----------;----------- ------------ -----------------------------------------------=------------- - -------------------------------------- ------ - - ---------------- Final Inspection by: --------- ------ - --- --------------------------------- Date T ~I �. 11' JOAQUIN LOCAL HEALTH DISTRICT [/ t E. H. 9 1-'68 5M