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.� - ' :-. p' rI FOR O; E USE: II r APPLICATION'FOR SANITATION PERMIT .. !I. Permit No. -�------- ---------------- ------------------ - -------- ------I� (Complete in Triplicate) , ----- - - ----- ----------I� �3—7 Date Issued __.y� ---•.-- ..1 This'Permit Expires-1-Year From Date Issued -------- s�itss� y 16�✓� Application is hereby madel,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: J08 ADDRESS/LOCATION 1__. --'-- - l�f`Ci '� "" ---CENSUS TRACT -------------------------. I ---------------- ----- ---Phone ,Owner's Name -�- �-------- ---�- -��'- --------- ---•----------- - ----_ - ' � Address �� a�- <,St�;---ll-_ cense # Phone Contractor's Name _____- - P Installation will serve: ResidenceXApartment House❑ Com erciat ❑Trailer Court '❑ Motel E]Other --/- --------- ---------------------------- "Number of living units:-----)------ Number of bedroor Garbage Grinder ------------ Lot Size . - - =< +�{ i Water Supply: Public System and,,name ------------------------------------------------- - --------.Private E Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan E] Adobe ❑ Fill Material If yes, type ------------------------ X11 u (Plot plan, showing size � lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) o septic tank or seepage pit permitted if�pu¢ is se erE�rS availgble within 200 feet,)�r• ( �l NEW INSTALLATION: (N p "u PACKAGE TREATMENT { ]'I SEPTIC TANK' =II____ _ '�_ -��- Liquid Depth ___ ___ ------- 1e (/�/ Material_[.Q/ No. Compartmen#s Capacity - Type -•� Distance to nearest: Well --------- --------------Foundation Prop. Line ----t- - "LEACHING LINE No. of Lines --------- -__ Length of eac line___ �_�__ /."----- Total Length _____ ----- 'D!' ri Box ____ ___._ Type Filter Materia - = G_110® t Fil er M teriai -------------� 1/1- " - Distance to neore t: Well ______+�— --_� --- Foundation ....._-� ---- Property Line, ____ -------•--- ' SEEPAGE PIT � DeMpth _-__ � _r__ Diameter ,��____ _ Number _._____ _ _ _ _ _ Rock Filled Yes No Y❑ Water Table Depth ------------------Al - ---------------Rock Size --___--- u� Distance to nearest: Well ---`-----�__ _ - --/------------Foundation --- ,;0"0.K_ Prop. Line ------ ------- REPAIR/ADDITION(Prev, Sanitation Permit# -•------"----------------------------------- Date ----------------------------------) ]I. .w L Septic Tank (Specify Requirements) -----------------A:-_----- ---------------- Disposal Field (Specify Requirements) '____________________ ___ ` --------------------------- ------------------------------------------------------ -- ------ k _ _________________________________________________"�__.____. (Draw existing and required addition on reverse side) I hereby certify that I ha le 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 tpe fiance of the work for which this permit is issued, I shall not employ any person in such manner ' as to beco a su ct ork sation laws of California." Signed -- -- --- -------- ------------------------------------- Owner ------------------------------- Title -------- ------- ---------------------------- ----------.---------------- (If other than" owner) 11 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED IrBY --------------- ` _------------------------------------------------------------------------. DATE �/ BUlLQING PERMIT ISSUED ___________________ ------------------------------------------------------------------------- -------DATE -------------•----------------------------- ADDITIONALCOMMENTS------- ----------- ------------------------------------------ --------------- ---------------------------------------------------- --------------------------- ----------------------------------------A--------------------------------------------------------------------------- ---------------- ------------------------------------------------------------------ i -�I -- ---------------- -------------------------------------------- -------- - -------------- --- ------ --- - --------- •------ -7------------------------------------------- (------------------ --------.DateFinal Inspection by. - -- Q----"------------------- ----- ----------•----- ------------------ _ ------ ------------- ---------- - AOAUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M � ,