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! zq--ZoO_r D FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. (Complete in Triplicate) Permit No. _7e-` rt '�' bate Issued :_Z__3 ------------------ ------------------- This Permit Expires 1 Year From Date Issued R i Application',is hereby made to the San Joaquin Local Health District for a permit to construct and inst II the work herein described. This application is made in compliance with County Ordinance No' 549 and existing Rules and Regulations: 4 JOB ADDRESS/LOCATION 1A ------ . -CE S RACT Owner's Name ----------- .- ---- - - - - -------------------------------------------- ---------Phone --------- AddreAddress ---------------- ss --------------- City 111/---- Contractor's Name . , _ ~ ;� ------- -------License #aZS`.Z1 _____ Phone V�_�' .. Installation(will serve: Residence ❑Apa rtmenj,H quse�❑Jommercial OTrailer Court ;❑ s , Motel E] Oth ----- - - -------- Number of;living units:- ---------- Number of bedrooms ------------Garbage Grinder ---` Lot Size - ----- ------------"--------- -------- Water Supply: Public System and name --------------------------------------4'-------------------------------------------------------------------------Privateo Character of soil to`a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat 5iZr San`dy�Loom ❑ Clay Loam f i Hardpan Ej Adobe Fill Material ------------ if yes,t (Plot plan, showing size of lot, location of system in relation.to wells, buildings,iketc. must be placed on reverse side.) aNEW INSTALLATION (No septic tank or seepage p't permitted if))ublic;se'-wer.is available within 200 feet,] PACKAGE TREATMENT I [ l SEPTIC TANKX- t .. Size xs $ ------------ Liquid Depth ----------------- C ---------------- { Capacity ( -------sTypi)4_ti&Z MaterialIS' C ------ No. Compartments ....... ......... { Distance to nearest: Well ,/C��____._�______________Foundation _�Q._ _______-- Prop. Line LEACHING LINE No. of Lines ____ _-/__--__________ Len th of each line3� j g ____ 4-a __ Total Length k-'D' Box ------------ Type Filter Material Depth Filter Material ---1.4?------------------------------ A Distance to nearest: Well ________________________ Foundation ---------------------.__ Property Line -_________________-_-___ SEEPAGE PIT [`] ' Depth -------------------- Diameter ________________ Number ----------------- ---------- Rock Filled Yes ❑ No i❑ Water Table Depth -------- ------------------------------.-.--Rock Size ---------------------- -•---- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _________________-.._.__-__-______) A 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 be e s blect 4Y W man's Coensatian laws of California."PIP f Signed - 1-— Owner � --------------------- BY ------ ---- o ----------- Title ------------- ------------ --- - --- -- ------ - ------------ (If..other than owner) FOR DEPARTMENT LISLE ONLY APPLICATION ACCEPTED BY ---- ------------------------------------- - - ---------- DATE 3 Z''------------------- ---- ---------. '- -- -------�------- BUILDING PERMIT ISSUED -- -------------------------------- -- -----------------------•--------- --- ----------------------------DATE -------------------------------------- ADDITIONAL-COMMENTS ------------------ -------------------------------------------------------------------- ---------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ----------------------------------------------- Final Inspection by:` Vii s °` --------------------------------------- Date �/-��rrc ? SAN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M }