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OR OFFICE USE: � -a ` 1 APPLICATION FOR SANITATION PERMIT -- ' � %. Permit Na_ ____ -3,-- -��--- ---'- [Complete in Triplicate) Date Issued _..�_:"'z_�- ---------------------------------------------------- ------ -------------------------------------------------- p This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. I JOB ADDRESS/LOCATION --- :--- ---- =,�}/f ' �� _ ENSUS TRACT ---------------•-•------- Owner's Name _ Phone.4.11_=-o��._..tD-------- I AddressCity 1df11�------- ---------------------------=d----------------------------------------- -- `.` •L f Q.e� ---------- ---------------------------•- i Contractor's Name - '?F- License # - - �� Phone -� = 7 Installation will serve. Residence ® Apartment House C] Commercial ❑Trailer Court ,❑ J Motel ❑Other ------------------------------- ---------- I� fi Size ----------- Number of living units:____I----- Number of bedrooms,--a-----Garbage Grinder _-ItI:C1: Lo ---------Private ICK Water Supply: Public System and name ---------------------------------------------------- ----- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam..1 Hardpan ❑ Adobe ❑ Fill Material _- if yes,type --------------------- ------ {PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed 'on reverse side.) �f! NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r h , ' / PACKAGE TREATMENT [ ] SEPTIC TANK;� `— Size--!57 �' � ------•---------- Liquid Depth .--�--------------•- Ca acit � Q <<-- Type �p�L'6TMaterial_z'� �No. Compartments _> ________________f! Distance to nearest: Well ---- 8 ---------------------Foundation --fes___ Prop. Line ol--=•-------0 I LEACHING LINE [A No. of Lines --------I-------------- Length of each line.-10-0---------------- Total Length ---/_-�wP--------. ---- 'D' Box -/]l_C2__ Type Filter Material -__Depth Filter Material _--- --- --------_______•---------•---- Distance to nearest: Well _15-V_`------- - - Foundation ----- Property Line. -_5---............. • ' �- . SEEPAGE PIT DepthDiameter ,3-6-11-------' Number -----I--- --- --//--;,.Z--- Rock Filled Yes No � Water Table Depth ---------------------------------------Rock Size Distance to nearest:Well ------I�0--`--------- ------ Foundation __�p-�.--------- Prop. Line -- --------------- I � . t REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------------------ ) � Septic Tank (Specify Requirements) ------- ---------------------- - -----------------------------..------------------------- Disposal ------ ------------------•Disposal Field (Specify Requirements) ------------ --------------------- ----------------- -----------------------------------------_----------------------------------------- -------- i (Draw existing and required addition on reverse side) I hereby certify that 1 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 ---------- - --------------- Owner ---------------------------- Title --� - ------------ ------------ other than own TMENT USE ONLY APPLICATION ACCEPTED BY - -------------- DATE --- �Z = ----- -- - - - - - BUILDING PERMIT ISSUED -------- ---DATE - ------- -- - ADDITIONAL CO WNTS - -- ----- - ---------------- .2.-/ - �, - ----------- tl Yl_ Q� rf ----------------------------- - - ----- --- -- - F Final Inspection by: ---- -----------------------Date --------- J ------- ------ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.