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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: 1_y_�76s --------_--------------- Thls 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 and Regulations: JOB ADDRESS/LOCA ON 471 ---- ----------- --------------- ---- .: .. w-CENSUS TRACT -------------- R fI ------------ Owner's Name L� � Ph n Address - L �� t ------------------ ------- - ---- Phone Z_ Contractor's Name ------- _ � f'{-- --.License # / -�� ------- Phone _-�-------------- ----------•- Installation will serve:--- Residence Apartment-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 + ! Hardpan ❑ Adobe ❑ Fill Material _:___.4---- If yes;type ---------------_____--______ (Plot plan, showing size of Ibt, location of system in relation to welds, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep ge pit permitted if public sewer is available within 200 feet,l SEPTIC Size' `- PACKAGE TREATMENT [ 7 ------------------- Liquid Liquid Depth __V------------------- Capacity_ --._ _ Type _______________ Material--- 'rMNo., Compartments __ _ Distance to nearest: Well ------- 9:1 -=----------------Foundation ------`V_!i------- Prop. Line �___ ----- �`i LEACHING LINE 1 .� ' - _ � f [ No. o lines ___________________ Length of each line--- Total Length ___ - '______--__._ % 'D' Box �--- 7 l ----___Depth Filter Material ------------------------------ 1/ Distace to nearest: Well Material --F ndation ---------�Q--- ------ Pro e�� i __ C_ 3p ty L ne ---------------I-.-- I - SEEPAGE PIT ( ] Deptli Diameter ____________ __ Number _._- ____________{_____ Rock:Filled Yes E] No 0 f - - f.J- - .y J Water Table Depth ------------------------------------------------Rock Size -------------------------- s Distance to nearest: Well _________________________________._-_--Foundation ---------------_- -- Prop. Line -----------._...._ r... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic -_------------------------------_Se tic Tank (Specify Requirements) ----------------------- NO Disposal Field (Specify Requirements) -----------•------------------------------------------------------------------------------------------------------------------------- ----- ------------------------ --------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 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 suto Workman's Compensation laws of California." Signed — - - ---- --- ------ ----------------------------------------------- BY y c ---------------------- Title -*-�c � (If other than owner] fOR DEPAitTMENT USE ONLY a el APPLICATION ACCEPTED BY ----------------------------------------------------------- DATE --- I--� ------------------- BUILDINGPERMIT ISSUED ----------- ------------------------------------------------------------------------------ --------------DATE ------------------------------------------- ADDITIONAL COMMENTS - ---- ---------------------------------------- -------------------------------------------------------------------- ----------------------------- --------- -------------- ..... - ---- ------------------------------------------- Fina Inspection by: ------Dater - � At----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M