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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT • ------------------- - --- --------- Permit No7/=--- . - - ------- - (Complete in Triplicate) �---7-1 ---------------------------------------------------------- Date Issued Id,77_Z1_,7_ -------------------- ------------------------------------- This Permit Expires 1 Year From Date Issued _ r � � Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: - lop JOB ADDRESS/LOCATION .......CENSUS TRACT __________________________ Owner's Name T'�� ------7------1 71" --------------------------------- -------Phone ---------------------------•-------- ---------- -- -- 1 Address __/� 3'j------�--- - p` � --------------------•-_. City ---- Contractor's Name ----- -------------------------------------------------- License # -a` - f.7.7__ Phone -4�_3'3----r'9 Installation will serve: .Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number of living units:_________ Number of bedrooms ---s3---Garbage Grinder ------------ Lot Size _�_k__lld____________________ ,f_ Water Supply: Public System and name -- :.lt-t.t�-----------�f�-------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam, - - , Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---F----------------------- -� (Plot plan, showing size of lot, Co ation 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 TANICM Size_____0/_A__67x_,/l0------------------- Liquid Depth ______ _______________ Capacity _A94-0-------- Type _ _ Material____ No. Compartments ------.%Z:-------- . Distance to nearest: Well ------------ _P_ _______________Foundation ______---a_-____-_ Prop. Line ________61_______ w LEACHING LINE . No. of Lines ----zA- -________.__ Length of each line--------APO `_._______ Total Length ------ 'D' ___-'D' Box .____-l._ Type Filter Material ___ ____Depth Filter Material ----------/9_"'_____________________ Distance to nearest: Well -----.S"4_r--------- Foundation --------/0-/------- Property Line ______1-17/.__........ SEEPAGE PIT Depth ___ �____. Diameter -.33��-__ Number ------------ ---_________ Rock Filled Yes No 0 Water Table Depth ---- -- X0,0 ------------------_--.Rock Size ---------v-------- ------------- _ Distance to nearest: Well -----APR---l_____________________Foundation -----IO�------- Prop. Line ...... - --------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------.----------------------------- Disposal Field (Specify Requirements) ------------ - --------------------------------------------------------------------- --------------- - --------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- --------- ------------------------------------------- (Draw ----------------------------- ------_(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: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------- -----.----_--- Owner -----/--�--------------------- -- ----------------------------- By I ----- - -------------- Title ------------------------------- (if - - - -- ---- ---------- - --- --- -------------------------------- (If other than o ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - ----- ------- - - -- --------------------------------- DATES- -x�`- ------------__---- - --------------------------------- BUILDING PERMIT ISSUED ----- ----------------- ---DATE --------------------------------------.---- ADDITIONALCOMMENTS ------------------------------------------------------------------- ------------------------------ ---------- ---------------------•--- ----------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- --------- ---------------------------------- - ------------------------------------------ ------------------ -------------- - - -- Final Inspection by: ! Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M