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i FQ ,OFFI�AE USE: APPLICATION FOR SANITATION PERMIT ` -f G ----- ° 3— •r,� -�- ---- Permit No, -------------�- -- ,� (Complete in Triplicate) ------------------� --------- Date Issued --�--`------_----� --------------------------------------------------------- This Permit Expires 1 Year From 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 . - Z3 . -- ------CENSUS TRACT -------------------------- �f� - ,�.LL Owner's Name ----- /"(i�m 114-------- - -- - ----------------------- Phone..T � C�0 Address -- ---- -------- '(� h ---- ----- ---------------------- City - "s ------- ------------------------------- s Contractor's Name ----------F.-- -•-- -- -� -__-- --_- '--- --------------- License # _ '��1._ Phone _ 6 ��_�__ Installation will serve: Residence %Apartment House Commercial ❑Trailer Court ❑ ' Motel ❑ Other -------------------------------------------- Number of living units:----/----- Number of bedrooms ______Garbage Grinder - ----- Lot Size 50--x 1 __________________ Water Supply: Public System and name ----------------------- ------------------------------------------(__- ----------------------Private ❑ Character of soil to a depth of 3 feet: Sand'EJ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe 56 Fill Material ------------ If yes, type _._______._______.________ YA (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,) JFr V PACKAGE TREATMENT [ ] SEPTECTANK Eze__ _____X_�--------------------- -- Liquid Depth --.�--------------------- � Capacity --- Type _40�______ Material_�Azt-G�__-_ No. Compartments ._ .. ......... Vr1 Distance to nearestWell ------------------------------------Foundation _-__L_P___________ Prop. Line ___ ,$- -__0'-0- - .______ LEACHING LINE �[ No. of lines ______/--------------- f ( Length of each line-____ __ _ _____.______ Total Length /� - D v 'D' Box ---------- Type Filter Material ___ ___-_-Depth Filter Material ____`_<F_________________________________ Distance to nearest: Well ------------------------ Foundation ----Z-4 Property Line -:�---..._.__-_-___ SEEPAGE PIT Depth y t Diameter -_3X`l____ Number ----------- ______-______ Rock Filled Yes V No ❑ Zai'' Water Table Depth -----------------------------:.._.......-------•Rock Size�-�-----------�---------.. Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line __________..__........ REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ________._...---- ---------------- Septic Tank (Specify Requirements) ------ ------------------------------------------------------ ------- ----------------------•-------- ------ ' Disposal Field (Specify Requirements) -------------------------•-•--------------------------------------------------------------------------------------------------------- 6 ---------- -----------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------- t --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 ` --------- Title ---------- - ----------------------------------- By ------- - --------------------------------------------- (If of r than owner) E RTMENT USE ONLY +� APPLICATION ACCEPTED BY ------ r -----------------------------------------------------. DATE = =/ -------------------- BUILDING PERMIT ISSUED --------- - - -- - --- ---- - - ---------- ----------------------------- _ -----------.--------------DATE -------------.-------_ --- -- - ADDITIONAL COMMENTS- __ _ 7)--------------- = -------------------------------------------------------------------- -- -------------------=-------------------- -- ----- - --------------------------------------------- ----------------------------------- --- ------ Final Inspection by: ------ ---------------------------------------------------------------------------------Date AN JOAQUIN LOCAL HEALTH DISTRICT + ' E. H. 9 1-'68 Rev.'"5M