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FOR OFFICE USE: ., ' w' *rb APPLICATION FOR'SANITATION PERMIT • ----- -------- ----- �- 1 y6 (Complete in Triplicate) Permit No. ----------- ----------------------------------------- o- ------_____- This Permit Expires 1 Year From Date Issued Date Issued _ -�--- _ -a 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -------------------------------CENSUS TRACT -------------- ----------- Owner's Name -- --- Phone ------------ --------------- - ------- -------------------- Address -- �r1f �-� / --------------------------------- cityG - -------------- ` `� _ ,fit , Contractor's Name _. ��%/�_x_�'¢---,:.J�ccJ_��__�ri �-_________ .License # _ �_ _.�_ Phone Installation will serve: ResidenceApartment House❑ Commercial ❑Trailer Court ❑ / 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 .E] Hardpan ❑ Adobe [� Fill Material ------------ If yes,type ________-_________________ (Plot pian, showing size of lot, location of system in rellati`on 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,) '" p PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size...... �_-_____-___________ Liquid Depth --__1;�_;----------------- Capacity ----____-__- -__Capacity _11k._oo- Typ �'rL_ NV-�__ Material-44' 'No. Compartments ____ °" Distance to Weare t: Well ____- /0p____________________Foundation ___/0------------- Prop. Line LEACHING LINE [ ] No. of Lines -__- -_ g t �- g .___________ Length of each line �s' �.�_____ Total Length ,_1.7 ------ i-A _.9,7 _____ 'D' Box J__ Type Filter Material � _��____Depth f=ilter Material _.__L:4 _______ ------------------------ f Distance to nearest: Well _ _,________` Foundation __!0___`_______ Property Line, ---4............. SEEPAGE PIT [ ] Depth _J6------------- -9i&"4e+er 4_!Y��___ Number __.___ Rock Fille�, Yes f No i❑ ------------ ' 1 Water Table Depth __________v7. ------------------------------ r� Rock Size � �---�-�-- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. 'Line ---------------------- REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date ___________.________-_______.____) Septic Tank (Specify Requirements) - ---- ------------------------------------------------- --------------------------------------------------------- Disposal Field (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 'no in a performance of the work for which this permit is issued, l shall not employ any person in such manner as to becom u ect to Workma 's Compensation laws of California." Signed ------ ......... --- --- --- ------------ Owner ' BY - - -------------- Title --------------------------------------- - � (if oth r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYJ -- - - -- -- ---------------------------------------------------- HATE BUILDING PERMIT ISSUED --------------------- ------------------------------------------------------------------- --------------DATE -------- ---------------------------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------- -------------------------- --------------------------------------------------------------------------------- --- - - ---------------------------------------------------------------- ------------------------ -------------------- --- -------------------- _ - = ----= - -- ----- _Final Inspection by: _: SA . JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M