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FOR bPFICE USE: APPLICATION FOR SANITATION- PERMIT { - z. _ .Per _. . . . -- - - - -•-� ---�`�K - � �1Camplete`in�Triplicdte? mit No. _ _..- ------ - - -- -- `� � ? Date Issued -------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATION .--f-- - + -- ----- ------- ------ CENSUS TRACT --- Owner's Name ----- = - ----- Phone --------------------------- -------- Address ------------ Cit Contractor's Name - n , '` u -------------------=--------license # ale, gzz_ Phone Installation will serve: Residence ❑ Apartment.House❑.Commercial ❑Trailet Court ;❑ Motel ❑ Other #------------------------------------------ ` Number of living units:------------ Number of bedrooms? ------------Garbage Grinder -.-_----_p- 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 ❑ t Hardpan ❑ Adobe ❑ Fill Material ____-------- If ye`s;y e`_.-° __________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must beplaced on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,). PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-------------------------------------I-__-__-__. Liquid Depth ----_.______-._-_-_-,_____ f _Capacity p .� Material__ o. compartments ___'�A................. Distance to nearest: Wel! ___________ ______________________Foundation _ __t_d--__- .-*'Prop. Line __.-45P_4�.......... �1 LEACHING LINE [ ] No. of Lines!- -------------- Length of each line--------- -Total Length ,___s-- -------------_....... s ,. D' Box ._____. --- Type Filter Material ____________________Depth Filter Material ____ ___` 3 .___.____________--E----__._ ' I Distance to nearest: ___-___Well ------------------------ Foundation ----------------- Property Line --------------- ........ SEEPAGE PIT [ ] Depth --------------------- Diameter _______________ Number --------------------- ------- Rock Filled Yes ❑ No ❑ �. Water Table :Depth ___ __- ________Rock Size ______ t 9 ------------------- ----- Distance to nearest: Well ----------------------------------- p. Line --_---------[-------- � ____.Foundation ___________________ Pro REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------ { Septic Tank {Specify, Requirements} ------------------- -------------------------=--------------------- ------ --..-------------------`-------- i Disposal Field (Specify Requirem - - ---- --- -------------- --- -------- ------------------ ------------ -------------------------- -------- - � �r- ------- ------- -- --- - --=- :` �. hereby certify that I have prepared this application and required ad -------------------------- ________________ i q addition on reverse tha [ - I e wor will be done in accordance with San Joaquin k County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or hcen- 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 ---------- ------- (If other than owner FOR ' s DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .__..____[--C _ __1L,[.__________________._____ _ ------------------------------------------------- DATE ----- - ------'?`-7 BUILDINGPERMIT ISSUED ------------------------------------------------------------ --- -- ---DATE _ -------- ---------------------- ADDITIONAL COMMENTS ----------- - a- Fiholinspectio i - -------- ------ ------------------------------11 --- -��id 3 --------------- --------------------- ----------- -------------------------- ---------- ---------------------------------------------------------- ----- ------------------------------------------------------ ` l ------ - - -- --- ='' f ,_ ----- --- -- ----- - ---------------------- Date _ - ---- ---- ? 4t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M