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�I- OR"OFFICE USE: ... ------------------------------------------- ------------------------ ------------- --------------- APPLICATION FOR SANITATION PERMIT' x ---- -------------- (Complete in Triplicate} "--- - �?t�rmit No: ""73^38� A - -- -------------- ----------- This Permit Expires I Year From Date Issued Date Issued pplication is hereby made to the San Joaquin Local Health District for a described• This application is made in compliance with County Ordinance No. 549 and existingRules permit to 'construct and install the work herein JOB ADDRESS/LOCATION es and Regulations: o - ------------------------ ------------------------ Owner's Name�qtj ---------CENSUS TRACT Address ---- ---- - Phone . --------------------------------- ------------------- ---•---- Contractor's Name --_ -- -- ---- - City - --- --------------------------------------------------- Residence ----- ---- ------ Instaflation will serve: - License # _ � - �......... Phone - --------- �- Residence Apartment House�❑ Commercial ❑Trailer Court ❑ Motel ❑Other _ ""-______ Number of living units:_-_I - ---- --------------------- -----_ Number of bedrooms3-_--___ 150 Water Supply: Garbage Grinder Lot Size pp y: Pablic System and name _. - feet: Sand oSilt Character of soil to a depth f 3 f ' + ' - - --------------- -- - - Private [] 0 Clay ❑ Peat El Sandy Loam -"" _"-"-"---"""-""� -- Hardpan ❑ Clay Loam ❑ p ❑ Adobe� Fill Material "_"-_.____ - If yes, type ----------------------------- NEW INSTALLATION: (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be (No septic tank or seepage pit permitted if public sewer is available within 200 placed on reverse side.) */_ PACKAGE TREATMENT [ J SEPTIC TANK:r 7 Size._""________ "" feet,) Ca acity ------------------- ----- Liquid Depth p ---------- ----- --- Type -------- Material---------------------- No. Compartments Distance to nearest: Well _-"___"-_- LEACHING LINE [ 7 No. of Lines ------___ -- F �--""---------Foundation ---------------- Prop. tine ----------- ------ Length of each line -.--,----------- °�.. Total Length __- - 'D' Box ------- --- Type Filter Material -------__ _-- -------•---- r , Distance to nearest: Well -------Depth Filter, Material -_----_--_ SEEPET ----- Foundation ---------- Property Line - Diameter � -----------------•=---- 1 � Depth --- -- -- ---- ---- - ----------- - Numbe, ._ �- - - - - Water Table Depth Rock Filled Yes ❑ No ❑ -------------`------- ---------•----Rock Size ------------------- -- -- --- Distance to nearest: Well "-_"-_"__-____ } - ------------------------Foundation ------ Prop. Line --------- ------------ Sept_ ------- s a REPAIR ADDITION Prev. Sanitation Permit# _.""""__._"_"'______'___"_ 4 Septic Tan Specify ecif Requirements) ate # 1 ' p y q Mie Disposal Field (Specify Requirements --------- ---- ------ ---------- )--- blow --- a . ------------- ------ - l ---------------------- ----- _ (Draw existing and required ad ----------------------- County / t ! herebycertify that ! have prepared this application and that th - - " - " ^" -- ------------------------------------------------------------------- -- - e dition on reverse side) -- ---- ------------------"""--- --- ----- - --- y P p - - - �w ne in- County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local oHealth District. Home owner or licen- sed sed agents signature certifies the following: "I certify that in the performance of the'work for which this permit is issued, I shall not em to an en as to becomes ject to Workman's pm cation laws of California." p y y person in such manner Signedk" - -- "---- ----------------- Owner By (If other than owner) --------- ---- --- - - ------- Title - ---------------------- -------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._" ___ BUILDING PERMIT ISSUED ................... ---------- ------------------. DATE ------- -a-1 _9a - ---- ------------------------- DDITIONAL COMMENTS --------------- -----------------------------------------DATE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- --------------------------- ------------------------ ------------------------------- --- --- Final Inspection b y. ---------------------------•--------------- --- - -- Date -- - - - -- -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'h8 Rev. 5M