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FOR OFFICE USE: APPLICATION FOR-SANITATION PERMIT ------------------------------ Permit No: (Complete in Triplicate) ----------------- -- ----,-----_--------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued --5-1----_7� 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 4e --------------------- - -------------------------------------CENSUS TRACT --sS- '/S- Owner's Name --1 -- _Cl.� ---- ------Phone ga 46 " f ------------- io Address 1J------- �i- - ---- ------------------------------------------------- - City -- 4 -----------•-------------- Contractor's Name ------- ------------------------------------------- --------.License # ---------:--------------- Phone -----------------_----------- Installation will serve: Residence 0Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:----I------ Number of bedrooms ---cV,,-__Garba_ge Grinder 1' --_ Lot Size ----!7----------------7d__....__-_ [ Water Supply: Public System and'name ------------- --------------------- -------------------------------------------------------- - ---------------Private Character of soil to a depth of 3 feet: Sand'❑ Siltn Clay Peat ❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe ❑ 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,} � ------PACKAGE TREATMENT SEPTIC TANK Size-- Liquid De tli --- I --l-- •• ------ capacity 44 Type _ _ s No-_. Com artmenMaterial Distance to nearest: Well ------ ___________________Foundation _/0 _______---_ Prop. Ltse . .. ...i.. ...... n LEACHING LINE `K No. of Lines ___ - --------------- Length of each line------ ------ Total Length _.................. D' Box ---k--_ Type Filter Material -----Depth Filter Material __-- --- Distance to nearest: Well -/[00-�___-__-__- Foundation /0_ ___------ Property Line. ............... SEEPAGE PIT [ Depth --- Diameter -4__--_ Number --.----.__-I------_------- Rock Filled Yes No Water Table Depth ------------------------------------------------Rock Size. � h Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---:----------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---.------------------------------I Septic Tank (Specify Requirements) --------------- - -------------.----------------- ----------------:------------._ --- Field (Specify Requirements) --- -_--_- t- -- `-e ----a�' "------�------- ------------------------- Disposal - � f ----------------------- ----------------------------- -------------- ------------------------------------------------------------------------------------------------_----------_----------------- - (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, 1 shall not employ any person in such manner as to become,�s�b* to cman's Compensation laws of California." Signed -------------------------- --------- ----------------------------------------------------------- Owner BY - Title ----------------------- - ------------------------------------------- �l (If other than owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED l -p- a -------------------------------------- DATE ----- - -------------------------- ------ f�3 -- = BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE ------- --- - -}---_ ----- ADDITIONAL COMMENTS ---- -- _ ( "y ----- ------- ------------------ - .5------ "- --0-------- ------fir------- 7_ 70 _ j� -------------- " z- 7O -- -- per"--' ----- - -- ----------------- ------------------------------------------------------------ X ----------------------------------------------------------- ----- ------- _ _ . _. ------ --- -- c Fina Inspection bY: ---•---------------- ------------------------ Date ---------� SAN JOAOUIN LOCAL HEALTH DISTRICT k. E. H. 9 1-'68 Rev. 5M