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- — FOR'OFFICE USE: fl APPLICATION,,oFQR SANITATION PERMIT (Complete in Triplicate] Permit No. ---.7 ------------------------------------------- - ii f! �__ This Permit Expires ] 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 E� �• -�--- --------------CENSUS TRACT -S- ---- ---------------- ---- --�---- - �- - ---------- Owner's Name ----------------------A - -- --Phone•-------- --- -----•----------------- :i {: Address ------------aw)(-:------- - Cit !Contractor's Name _ A. - � cense # Phone Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑ Other = --- -------------- Number ---- ------- �. Number of living units:-------- Numbier of bedrooms - ___�Gorbage GrGr noer Lot ize ____ -�� Water Supply: Public System and name -------------- - -------------•----------_ ---------Private Character of soil to a de th of 3 fee#: Sand Silt Ga ---Peat`-�------5_______.----•-------------------- �.. 0 y ❑ ❑ Sandy Loam ❑ Clay Loam (] :� rY Hardpan Adobe Fill Material -________ If es, < _': p ❑ ❑ Y type �; ----------- (plot --- - . (Plot plan, showing size of lot, location of syst m in relation to wells, buildings, etc. must be placed'on reverse side.) NEW INSTALLATIOW (No septic tank or seepa a pit permitted if public sewer is a�1'ilable within 200 feet,) w O } PACKAGE TREATMENT [ ] SEPTIC TANK, J Size____________________ ______._ Liquid Depth --------____._.._.___: 1 Capacity -(----------------- T pe -------------------- Distance ----------------- Material- Na. Compartments ,;: Distance to nearest: W II ------------------------------------Foundation ---------------____-- Prp. Line --------"----=i%-•--- �� LEACHING LINE [ ] No. of Lines ------------------ ----- Length of each line--------_--___.--- - -_ --- Total Length ------------ T : ---r't'e w h 'D' Box ------ --- Type Fil r Material ____________________Depth Filte Material ----------------- Distance __-__ _Qistance to nearest: Well ________________________ Foundation _-_---- -- __-__._____ Property,, Line ____-._ SEEPAGE PIT [ ] Depth _ -_.._ _ _____ Dia eter _______________ Number _____- ___._ _____ _____ Rock Filled Yes ❑�� No I❑ w Water Table Depth ---------------------------------------- _ - ------Rack Size Ik x. 4i --------------- Distance to nearest: Well -----------------------•---------• Foundation -------------------- - �--y------ � - - s �;. Prop, ------------- REPAIR/ADDITION{Prev. Sanitation Permit# ________ ------.____________________________ Date ----- Septic ___ Septic Tank (Specify Requirements) - '/-------------------------------=-------- - Ii k --------------------- Disposal Field (Specify Requirements) ;_, __________________ ________ _ _ - - - (Draw existing idnd 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 signaturg certifies the following: ' "I certifyth in th t { perfor ce o e work for which this permit is issued, I shall not employ !ny person in such manner as to beco a subje' to W r ma ompen�rr,,tion laws•of California.'. Signed �- - 'C��_ k € - --- Owner BY - ---------------- ----------------------- --------- Title,-------- ----- -- (If other than owner) iC � FOR-DEPARTMENT-USE_ONLY APPLICATION ACCEPTED BY == -----------'r -X-. - ?'` DATE . BUILMNG..,PERMIT ISSUED--------- --4 Y w, - ---------- m ---.------- -: ----- - .-----DATE --- ----------- -- ---=-•-- ADDITIONAL COMMENTS _ - --�-- - ---- - --� ---------- ------------------------------------------ ------------ ---------------------•------------------------ ------------ ----- ,F ----- ----------------------------- - ----- ----------------------------------------------------------- ------ ------ -------------------- ------ -------- --: - --------�--------------------- -- - ---- -- - --- ----------------------- -- - Final Inspect I -------Date _..-- -._-' -- --- - -- ------- -- - -------- R I1 SAN JOAQUIN LOCAL HEALTH DISTRICT- E. H. 9 1-'68 Rev. 5M j`