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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------- (Complete in Triplicate) Permit No. _774/_ ----------- Date ---_--._._Date Issued _________________________________________________________ This Permit Expires 1 Year From 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: f/1�: / - ----CENSUS TRACT -------------- ---- JOB ADDRESS/LOCATION .__ �_�_________________________ ._. Owner's Name --------------R_Ar-IX4— ,------v-___--- - -�-------- ----------- -- Y----Phone �/ Address -------------- ---------------� - 4 dl��-�� _e---------------- --. city --------------------- ---------------------------------•-_-----------•------ Contractor's Name---- - h��-----------------------------------------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 ------------ 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 [ I SEPTIC TANK; Size___________________-►►_``--_________._-_______-_ Liquid Depth _________•-.__-----__-__- Capacity� _ Type 1 MateriaiC,1�'XV No. Compartments ___ ,.. Distance to nearest: Well ----� 7 Foundation----1,0 ...... Prop. Line �____ LEACHING LINE X No. of Lines _ 4------------- Length of a ch ine_-7409----- Total Length ----- 'D' Box ------1---- Type Filter Materialt - _ Depth Filter AApterial ___l_ ',rrc .____________ Distance to nearest: Well -----/jz _V.' Foundation ----- _ `____ Property Line - SEEPAGE PIT [ ] Depth ___________________ Diameter _______________ Number ---------------_------------ Rock Filled Yes ❑ No C1 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation ___________________ Prop. Line .................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ----------------------------------------------•---------- Disposal Field (Specify Requirements) __________-_ ______________ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------- --------------I----------------------------------- ------------------------------------------------------------------------ -------- -------------------------------------------------I--------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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: "1 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 Own _ --------------------------------- B Y ------------------ Title Title _ 1�z � 'Z - i'� (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- --- - -.-----------------------------------------------------------------------. DATE ------ BUILDING PERMIT ISSUED ----------------------------------------------------------------- ------------------------ -------DATE ------- ----------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------- -------------------------------------------------------------------------------------------------- -------------------------------------------------- -------- ------------------------------------------- ------------------------------------------------------------------------------------------------- -- -- -�y,-A J oZFinal Inspection by: Crt; - - Date . ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M