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FOR OFFICE USE: 1 APPLICATION FOR SANITATION PERMIT _2_(_ 7 l 5 Permit No: (Complete in Triplicate) T- 7- - V ------------------------- ------------------------------ S-- 1 I --_-------------------------------------------------_-- 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 .1-- - - ----------- - --,r_� n_� � CENSUS TRACT '�� e `el � llL`? X I � � i `e c.} Ct' -----_--Phone Owner's Name f__1 _ 5 'Address __.." _'0_0--- ---� -----c1- ----------- City --------------------------------------- 70 pp Contractor's Name _l_rA._ ''-- c _ __`S`e_f�r��- -i--------`-_e �00.License # _ _ ��5_�__ Phone Installation will serve: Residence KApartment Nouse fl Commercial :❑Trailer Court f❑ Motel ❑Other -------------------------- ----------------- / 71 Number of living units:_____I_____ Number of bedrooms _ --_Garbage Grinder __----__ Lot Size _4-� --'1---M(1---••• Water Supply: Public System and name ---------------------------------------------------------------------------------------------------•----------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ Hardpan 0( Adobe-M 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,) w PACKAGE TREATMENT [ ] SEPTIC TANK size----�'T_•:--�Z/r`-- 9 ---- Liquid Depth ------7-M------------- Capacity --J--- -- Capacity _/'421-'fa_17ype - -- --- Material 4P0 0 I L-1'e— No. Compartments ------��_r_••.....----. c, Distance to nearest: Well _________Fou/ndation ----/�_l----- prop. Line .-_--- LEACHING LINE [ No, of Lines --Z----------- Length of each line-y_ fes- ----- Total Length __� - --Z D' Box - fte _- Type Filter Material __V- ._`________-Depth Filter Material ----- - -��-------------------•------ Distance to nearest: Well ------ Foundation ------ --------- Property Line. lJ-------- k SEEPAGE PIT [ Depth �^---- Diameter Number __---------- _..---------- Rock Filled Yes 20 No .[ Water Table Depth ---------- -------= .'`Rock Size ------ --------- e Distance to nearest: Well ------ - -------------Foundation _ /, _r Prop.-Line ---SCI----- •- REPAIR/ADDITION(Prev. Sanitation Permit# _ ----•---------------------------------- Date ---------------- .---------------1 ------ : t, p-�' - -----:-------------- ---- - Septic Tank (Specify Requirements) --------------------- �- ' - """"'"""--"""""""-"""•" Disposal Field {Specify Requirements) ------------------ ------------ ----------------------------------------------------------------- -------------------- - ---------- ---- - ----------------------------- -------------------------- --------------------------------------------:---------------------- ---------------------------------------------- -------- (Draw existing and required addition on reverse side) r 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 issued, 1 shall notemploy an y person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------- ------------------------- ------------------------- ------------------------------ Owner Y ------------------------------------------------------- Title _.. ------ ----------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -fes ---------- --------------------------- DATE --------- --------- BUILDING PERMIT ISSUED - ::='--'---------- -------------------------- - -------DATE ----------- --- --------------- ADDITIONALCOMMENTS -------------.---------------------------------------------------------------------------------------------------------------- --------------------- -- ----- ------------------------------------------------- ------------------------------------------- ---------------------------------------------------------------------- --------------------------- ------------------------------------------------------------------------------ --- ----- ----------- ------------------- ---------- ---Z---�, � -------- FinalInspection by: ----------------------------- - ------------------------------------------- Date -- ----- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT F- H- 9 1-'68 Rev. 5M