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.rte A � wr FOR OFFICE USE: .,; �, -- APPLICATION F}. SANITATION PERMIT ----Y------------------------------ -------- ` - � Permit No. 1a-�67... ' (Com ., ,in Triplicate) •' Date Issued 7U ----------------------"--- :" ---_--------------------- This Permit Expires 'i 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: r� JOB ADDRESS/LOCAT ON .......... t _4 � __ CENSUS TRACT _-S_ ------------- (f Owner's Name ---zl. � ��, Phone 13 ` -`�//3 Address ------------ ------------------------------------------------- City ---- r -------------------------------------------- Contractor's ---------- ------- --- ------------------ Contractor's Name ------License # ------------------------ Phone -------------------•---•-- Installation will serve: Residence FE,Apartment House❑ Commercial ;❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:------- --- Number of bedrooms .----d_'__-..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'❑ FillMaterial ------------Tf�Yes,type--=----_---=-----==---_-=---- . 1 (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,) 6 PACKAGE TREATMENT [ ] SEPTIC TANK-T ] Size------------------------------------------------ Liquid Depth ---------------- ---------- -.0 0 1 Capacity --- ------ -------- Type -------------------- Material----- ---------------- No. Compartments ............. Distance to nearest: Well ----------------------------------".Foundation ---------------------- Prop. Line --------------------- LEACHING ____________:___ -LEACHING LINE [ ] No. of Lines ________________________ Length of each line---------------------------- Total Length -__ i 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------.-----------------.----- �+t1 Distance to nearest: Well ------------------------ Foundation ------------ Property Line -_-_------.__._.- ....... � .{ SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No C] Water Table Depth ------------------------------------------------Rock Size ------------------- ----------- i Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------- ------------ 4 REPAIR/ADDITION(Prev. Sanitation Permit# _.___... ----------------------------------- ____________) - - ---- - Date ---------------------- SepticTank (Specify Requirements) ----------------•------------------------------------------------------------------ --------------------------------------------- ......... Disposal Field (Specify Requirements) --- �'� _ _ ____ ��.y __ _ ___ � __`__ A-� __�__- { - v-- ------ --- z,G' �y �t s /� ' --- ----------------------------------------------------'-----------------------------------s------ ----•--•--------- (Draw existing on( jrequ fired ddiiition an reverse side} - I hereby certify that t have prepared this application and that the work will be donAn accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulation's 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 subiect to Workman's Compensation laws of California." Signed - -- . --- ----- - ------------------------------------ Owner r BY ------------ -------------------------- ----------------------------------------- ----------- Title ------------------------------------ ---------------------- ------------ i (If other than owner) 141 FOR DEPARTMENT USE ONLY �E- G DATE _�! / O-•-- I APPLICATION ACCEPTED 8Y ____ _. _ ____________ BUILDINGPERMIT ISSUED ---------------------- ------------------------------------------------------------------- --------------DATE -------------------------------- --- 1 ADDITIONALCOMMENTS ------------------------------------------------------------------•---------------------------------------------- --------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- ---"------------------------------------------------------------------------------------------------------ ------- ---- - - -- ---- ----- -- ------------------------------------------------------------- - --------"--- - - -- Final Inspection by: ---- - - - ---- - - ------ - ---------------------------------------------------------------------------.Date Al" - � ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 T-'68 Rev. 5M.