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� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 J - Permit No: - ---------- 3; (Complete in Triplicate) ---------=----------------------------------------------- --._....--.__------- - --------- This Permit Expires 1 Year From Date Issued Date Issued . -_c�-6 42 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ismadein compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESSAOCATI ----1_--7 '1'`' ------------------ ---------------CENSUS TRACT --------------•---------- Owner's Name ---•-------------------------------- -------Phone ------------------------------------ Address 7 Contractor's Name ..-- - - { -I---- --- -- - �---- -- -- -- -- �-•--- City ------- ---- - -- -- --- - --- ---- _ -----.License* 1-9 ----- Phone ------------------------------ k" ` Installation-will serve: . __Residence.{ Apartment.Douse❑_Cari�mercial ❑Frailer Court„ Motel ❑Other -------------------------------------------- Number of living units:------ Number of bedrooms Z-------Garbage Grinder ------------ Lot Size .___Cc Water Supply: Public System and name- ________________ ________ _ Private ---- - .! 1, ----------------------------------------- Character of,soiI to a depth of 3 feet: Sand El, . Silt❑ Clay-o' Peat❑ s Sandy�Loam ❑ Clay Loam. �_=�arcJ an= }"=Adobe-.""fitl7latertaY `'stf=eS, ��.. _: P` ❑ ❑ Y type ----- (Plot plan, showing size of lot, location of system;in 'r6lation 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 2t?0 feet,) � I / PACKAGE TREATMENT SEPTIC TANK [ Size=�fQ_ X-- --s�------.---- Liquid Depth _ _ --------------- Capacity �4-- -- -, - Type ACJ-- Material--_(t .___�No. Compartments --s ------------- y + r 1 I Distance to nes st: Well ---------.-�------------------[Foundation ------/_0-----------Prop. Line ---S-------------- LEACHING LINE No. of Lines ------, '- --?- -- Length of each line_--------/-q-0_- -- p x� _ r� �t ----- Total Length -----47 6� ;•' i' � 'D' Box .-`"!_.�.__ Type Filter Material -,Depth Filter Material ,___to/-_----_____ ! F f / t Distance to nearest: Well--== p__=-__----Foundation ---/-4!P-- Property Line- __5------------------ Diameter -_ + SEEPAGE PIT [ Depth --------S_�_-C.- d7_�._-._-_- Number ___ _ �- . �a ------------------ Rock Filled Yes ff, Na ❑ Water Table :Depth ------------�J0-----------------------------Rock Size / it Distance to nearest: Well --------------1-0-0------------------ ------t_O_--------- Prop. Line ----c '___:__------ REPA]RJADDITIQN(Prev. Sanitation Permit# -------•------------------------------------ Date ----------------------------------I ( Septic Tank (Specify Requirements) ---- -- ---------------------------------------------------------------------------------=--- - ------------- Disposal Field (Specify Requirements). ------------------------------ ---------- ------------------------------ --- { ------ ------------ ----------------------- ------------ ;!i (Draw existing and required addition on reverse side) I hereby certify that I haveprepared 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 [icon- sed agents signature certifies the following: "I certify that in the perfor3nance of the work for whith Nris permit is issred, I *hall notIo 4n sa&manner e�np r arty pw:ew as to become subi t Workman's Componsatwn hws of California." t` i. r{ Signed ------ ----- -- Owner, By ------ -------- ---------------- (ITitle ---'--- - ---------- ----------------- ------------ ----- --------------------------------------- f of than owner) .Dfh ONLY APPLICATION ACCEPTED BY ----------------------- DATE Q---------------- BUlLDlNG PERMIT ISSUED :_ ------- ----------------------------------------------------------------DATE ------------- ------------ ADDITIONAL COMMENTS - - --------------------------------------------P------------- ------ ------------ -------------.----------------------------------------------------------------------------------------------------------- -----------------------------------6 ----------------------------- -, .. FinaInspection by- -------------- ------------ ----------- --------------------------------------------------------Date ----&--------�--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.