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FOR-OFFICE USE: XAIPPLICATION FOR SANITATION `PERMITPermit No.- - _ omplete in Triplicate! ermifi Ex ires 1 Year From Date Date Issued_ _ _ _ This-P p Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein application.is made 'n compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This app / Zr� I•lil?Gp�� s� �z� ', ley JOB ADDRESS/LOCATIONl�1 - ------CENSUS TRACT ------------------•-•----- Owner's Name IJpell.----.1-�--- / /5t ------AA— Phone ------------ --------------------------— 4 Address - ------------ -------- --- --------- -- - Cit -- ---•-------- ------- ------- ------- Phone Contractor's Name ----- - Installation will serve: Residence ❑ Apartment House Commercial ❑Trailer Court '❑ f ❑ Other 1/,�F'�1 -------------------- Motel 1 nd _ , /�-'----'---- '�t - Number of living units:- ^- Number of bedrooms ___-_�--Gdrbage Grinder ________.:__ Lot Size -- � ------------------------------------------------------ Private Water Supply: Public System and name --------------------------------------------------------- _____--------------- -- Character of soil to a depth of 3 feet:— Sand. Silt❑ Clay ❑ Peat❑ Sandy Laam ❑ 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 if public sewer is available within 200 feet,) ff`f ---- q P i d, SEPTIC TANK: Size-9��---�'- - �Li Liquid Depth --- ----•----• --- PACKAGE TREATMENT { ] � el 1 y' Materials//!, �No. Compartments _-------••• _7. Capacity .------ -Type . `. ,_,:/. - ` -----------------Foundation-.la------- ------ Prop. Line -- -------------=-- Distance to nearest: Well ____ rte---= ____ Length of each line--A0Q----------------- Total Length - p ------•--------- LEACHING LINE ,fid No. of Lines_____ ______ -- g f- 'D' Box��T-- Type Filter Material [ ------Depth Filt� Material -------, ` 1 r r Distance to nearest: Well' ---- - Foundation AQ------------- -- Property Line -5------------------ SEEPAGE PIT Depth ----- Diameter ---------------- Number .--------------------------- Rock Filled Yes [] No 0 [ � p Water Table Depth -------- -------- ------------------- ------Rock Size -------------------------------1, Distance to nearest: Well ------------------------------------•- - Foundation -------------------- Prop. Line -_------------------- j ----------- Date ------------ ---------------------) REPAIR/ADDITION[Prev. Sanitation Permit# -------- k Septic Tank (Specify Requirements) ------------------------------------------------------------ --------- ----------- -------------- ------ -------------------------------- -------------------- ' Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------------------t: ------------------------------- ---------------------------------------------------------------------------- -------- -------- ----------------------------- _ --------------------------------�------------------------------------------------------- (Draw existing and required addition on reverse side) I 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,fallowing: "I certify that in the perfo/owner a work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Wamp on 1 sof California." Signed --------- ----------- -- -- -------- --- ------- ------------ Owner -------- Title - - - -- -- = ° (If oth r thq FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____ ----------------------------- -- ---- ---------- -------- - DATE __�_^��-��"--•------•----•---- BUILDING PERMIT ISSUED ------- -------- DAT -------- ------- -------- ------- -------- ADDITIONAL COMMENTS --------1-------------------- --------------------------------------- - --•-------•---- - -------------------------------------------------------------------------------------- ----------- _ -� ---- - -_ -------- a . -� ----- -------------------------------------- - d ---- Final Inspection by: _ ------- ----------------------------------------------------- SAN -------------------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E- H. 9 1-'68 Rev. 5M