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FOR OFFICE USE: ppp�ICATION�'''FOR SANITATION PERMIT -----------------------------------•--------------------- Permit (Complete in Triplicate) ----------------- ---------------------------------------- This Permit Expires 1 Year From Date Issued 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 made in compliance with County Ordinance No. 549 and existing Rules land/Regulations: JOB ADDRESS/LOCATION ._._ -- ---- - -- ---- -- ----- ENSUS TRACT ��7------------- Owner's Name -- R' -----------------------•-------••----------------- -------Phone ---------------------------•-------- Address ---- F� � -----+6--' CitY --------------------- - ---------------------------------------------•------ f Contractor's Name �� ---T-'-------------------------------------------------------------- Li nse # Phone 4 Installation will serve: Residence 49 Apartment House ❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- rr Number of living units:-----1----- Number of bedrooms __0-------Garbage Grinder ----- ------ Lot Size __ -_____________________________ 1 Water Supply: Public System and name --------------------------------------- ----------------------------------------------------------------------Private�] Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam�q , # - 3- �:Hardpan-* Adobe O Fill Material --`--------- If yes,type ------------------- (plot -------------=--(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,) PACKAGE TREATMENT [ ] SEPTIC TANK;* Size___-t_j_,y_d._---------------------- Liquid Depth --------------- Capacity _/.X_------- Type --4 _ Material.---Ir'r_1- ------- No. Compartments _-2-________________ d . Distance to nearest: iWell -----------------------Foundation _.4---_-------------- Prop. Line ---�____________ LEACHING LINE ] No. of Lines --.�____``_-_______ Length of each line._,��--------- Total Length ,_z-- _________.___. 'D' Box}✓A.-_'%_ Type Filter Material �r_�________Depth Filter Material _�-�--��--------_----------------------- Distance to nearest: Well __��__�___________ Foundation -----/ If-- ---------------- Property Line ................... SEEPAGE PIT [ ] Depth _ ..' --10 3------- Diameter 5-3- -------- Number --------------------------- Rock Filled Yes 25 No Q Water Table .Depth a `----------------------------------Rock Size ��" '------------- Distance to nearest:Well ./P:P_------------------------------Foundation _f4'____.______ Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# _i:_7__'.7777--------------------------- Date ---------------------------------- •' .—_� SepticTank (Specify Requirements) ------------------- ------------------------------------------------------------------------------------- ------ 1 Disposal Field (Specify Requirements) `"^ .. " f --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- G ------------------------------------------------------------------------------ ----------------------------- _______---------_-----_-_______ ____--_---_.__---.____-_-.__-.------.-----------_________ -; _(D.raw-existing_and._required add ition_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 th}.tri he perform a he work for which this permit is issued, I shall not employ any person. in such manner as to I fine s ject to W Compensation laws of California." ; Signed --------- Owner BY ---------- ------------------------------------------------------------------------------------------ Title --- --- ------ - ----------------------------------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY : --------------------------------------------------------- DATE f•- ' f� ------ BUILDING PERMIT ISSUED ------------------ -------DATE _..------------------------------•--------- ADDITIONALCOMMENTS -------------------------------------I------------- ---------------------- ---- ------------ ------------------------- ---------------------------------------- --------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ ----------=----------------------- -- -- - FinalInspection by: -------- --- - --------------------------------------------------------------------------------------Date 7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM )