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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 6p-�� <, Permit No. C� (Complete in Triplicate) ---------- --------------------------------------------- Date Issue --------------------------------------------------------- +' This Permit Expires 1 Year From Date Issued C-1a / 1k(6&_%V14e 7 U , Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wort/ erem described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. JOB ADDRESS/LOCATION _l-__�-�----��---�R- ---� ____-1�90_ -�--------=---- CENSUS TRACT -------------------------- # Owner's Name , r ��r 1�1 T` 0, Phone_ - - Address __-2�_A4- -----------------------------------------.------. City .:. - ------ ------------------•-----.---------- .� ----License # ------------------------ PhonerY4e . Contractor's Name _ - Installation will serve: Residence DCApartment House❑ Commercial:❑Trailer Court ❑ C � Motel ❑ Other -------------------------------------------- Number --------------- ----- ----- --------------Number of living units:--l--------- Number of bedrooms _______Garbage Grinder ------------ Lot Size Water Supply: Public System and name ------------------------------. -•--- ------ --------------------------------------- -----Private;? �I Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay .❑ Peat❑ Sandy Loam (] Cloy Loam,❑ Y Hardpan E] Adobe, Fill Material ------------ If es,type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public s weVs�c ilable within 200 feet,) SEPTIC TANK![ Size X'2'1---------- Liquid Depth ------- ---------------- PACKAGE ------------ --- PACKAGE TREATMENT [� l r q t uc Z Caaci 'L ------ MateriaI__�d}�---------- a. Compartments ___•------------------ s P tY -- i Disfiance to nearest. Well �__��----------------- -----Foundation __f�------------ Prop. Line ---�------ ---- f ,�.------------------ Length of each line------��` � LEACHING LINE [� No. of Lines __'2 ___________ Total Length :�i�-.--- �. ept Filter Material ---�C� ----•-------------•-------- f D' Box -- Type Filter Material ---------- `7----------- Property Line �� ------------- ( Distance to nearest: Well _1_4_�___`/___ Foundation __---- _ _-- - - - P'` . j SEEPAGE PIT Depth -_2 ------- Diameter � Number Rock Filled Yes No j❑ ( Wafter Table Depth ------:7_0---------------- -----•-----------Rock Size -------2 -Pa� � Distance to nearest: Well ----------------- -Foundation ----1 -------- Prop. Line . -=-------- + -------- Date REPAIR/ADDI7ION(Prev. Sanitation Permit# -. - - -� 1� - - i + Septic Tank (Specify Requirements) ------------------------------------ ----------------- Disposal Field (Specify Requirements - -------------------------------------------------------- - ----------------•----- ----•---- ------------ - - -- - --------- ------------------------------ ---------------- ---------------------------------------- --------- ------------------------------------------- (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 following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to beco object to 79 Workman's Co nsation laws of California." Signed ----- - - -----61---- - -- -------- - ----------------. Owner ___ - - ------------ Title ------------------- ---------------------------------------------------- ----------------------- - ---- (If other than owner) if FOR DEPARTMENT USE ONLY - -- - ---�`��------ ------- DATE 7_'7 3 APPLICATION ACCEPTED BY __ _--_ ----------- ----�------- - BUILDINGPERMIT ISSUED -------------------------------------- ------------------------------------------------------------------DATE ADDITIONALCOMMENTS --------------- --------------------------------------------------------------------------- - o }� ---------------------------------- 7 --- 2 .S i ter„-! ------_�--- `_ - ------------------------- - g > 6 Final Ins ection b - --------------------------------- - ------Date"_: '__. � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM.