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FOR OFFICE USE: = - ------------------- -------------------------------- APPLICATION FOR SANITATION PERMIT ---------------- (Complete in Triplicate) Permit No. ------------ ! 7 a.,. b� _____________"___-..." 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 constru t and�i install f . pp Y all the work herein described. This application is made in compliance with County Ordinance No. 549 and existifig Rules and Regulations: JOB ADDRESS/LOCATION ,,. i_2+r_kENSUS TRACT Owner's Name - _ ------------------ Phone "?`. -_ ® �ls°a - Address -- - -------- • --D----, City -- Contractor's Name % - -------------------------------------------License # --------.-----------.-- Phone ------------------------------ -- - - Installation will serve: Residence [ Apartment House,❑ Commercial ❑Trailer Court i❑ Motel ❑Other--- Number of living units:---- ------ Number of bedrooms ---i-_---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 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 ifpublic sewer is available within 200 feet,) \�V PACKAGE TREATMENT [ ] SEPTIC TANK Size-T "'�"_ '.t'-_ -------------------- Liquid Depth .- __--------------- V7 Capacity /07-A-0------ Type I"1,4, Material"_ _----- No. Compartments - ' ____________ Distance to nearest: Well ----- D------------------------Foundation _- /0_---------- Prop. Line ---_d--..„!.......... LEACHING LINE No. of Lines __ _ J c -______ Length of each line__: �'�--44 9 Total Length—.../6-0-._ 'D' Box G-r- -- Type Filter Material -DCA') r__----"-Depth Filter Material __11"--------------- Distance to nearest: Well ---jt --------------- Foundation -----(v_)--__-_-._-_- Property Line -15-./................. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -__----__------------ -----"--------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date Septic Tank (Specify Requirements) 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 subject to Workman's Compensation laws of California." Signed -------------------------------------- Owner By ----------------------- - ----------------------- Title ------------- -- -------------- - �r (If of r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - -- ---. DATE _14-AP-701f,------------- BUILDING PERMIT ISSUED ------- ___ _ -_- --" J �f -- f DATE - _- . --" COM ENT _ _ ADDITIONAL _ - - -= - ----- C! 2r..u-- --- -- - --- --- - ! Final Inspection by: - . ______ ----------- -- - ----------------------- --- ----------- - -- - - - - -- - - ----------------- - ------------- ---------------------------- -----------------".Date�-�--- `�-------=- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M