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FOR OFFICE USE:( ' A I APPLICATION FOR SANITATION PERMIT Permit No: l ~_ / (Complete in Triplicate) ------------------------------ ------------ This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS/LOCATION __-t----------------------------:----CENSUS TRACT 67 Owner's Name ------ -- —------------------------- Phone � _4/ Address I r ------ Citi l��c s Name � _ `_ 'x _ _��__ � _ j �-,---_- _.License # f 1,3-. Phone -------------------------_- Contractor Installation will serve:' f.' sidenceXApartment House-0 Commercial :❑Trailer Court 10 Motel ❑Other -------------------------------------------- Number of living units:---_ ------ Number Number of b drooms Ga;_LejGr;iTnr .-- .__--__ Lot Size __.-____ --- --Water Supply: Public System and name __ ��_LC_J. ��.____________________ _________Private ❑ Character of soil to a depth of 3 feet: Sand' !/Silfi P ❑ ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe X Fill Material ------------ If yes, type --__-_-_-._-______-----__ (PI'ot 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,} ( , PACKAGE TREATMENT [ SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth ____............ ..-•--• W Capacity - -- --------- Type -------------------- Material---------------------- No. Compartments -------------•-•---•-- Distance`to! nearest. Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------_ ' LEACHING LINE [ ] No. of Lines -----------------------*__ Length of each line---------------------------- Total Length ------------ .---___-_--._. f 'D' Box ------------ Type Filter Material .--------------------Depth Filter Material ------------------- ------------------------ . Distance_ to�nearest: Well _________________---___ Foundation ------------------------ Property Line ------------------------ SEEPAGE PIT [ } Depth __________________ Diameter{r_____ -__--- Number .--_-.-__------_ Rock Filled Yes ❑ No I❑ Water Table Depth ----------- -------------------------stock Size ----------------------------- I .: } --Foundation -------------------- Prop. Line ---------------------- il Distance to Barest: Wel! --------- ---------------- -- REPAIR/ADDITION(Prev. Sanitation Permit F# -------- --------- ----------------------- Date --------------------.-------------} i r i Septic Tank (Specify Requirements) -------------------------- ---------------------------- _____ xy - r I ^,R-DisPosal Field (Specify Requirements) _------ ------------- __ _ ______� ------- ------------------------------------------------- ------------------ v(Draw existing and r'equired addition on / 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: "I certify that in the performance of the work for which this permit is issuedr I shall not employ any person in such manner ' as to hec bject tokwkja 's C ensu Vaws of Cali#ornia."Signed . _ll� ' .............. ,: f By ----- � ----------------- Title ---------------- (If other than owner) FOR {{{DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- c�- f<` DATE _ BUILDING PERMIT O ISSUED ---------------i---------- ---------------------DATE -------- --------------------------- ADDITIONALCOMMENTS I---------------------------------------------------------------------------------------------------------------- --------------------------- ---------------------------------------------------------- --------------------------------------------------------------- --------------------- - Fi -- inspection y. ---------�� E�i?l� Date/�c.�l✓ - Final Ins ection b I l SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev.SM �