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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT = -------------�- ..`�' 6� • ��, r (Complete in Triplicate) Permit No: _______________Q ---------------- ---------------------------------------- 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 Re dations: JOB ADDRESS/LOCAT N . /-7-!` *�,J "` -------------------- ---------CENSUS TRACT ° ' Owner's Name ,G� ----�---�-1-------------------------- - --- -------- -------Phone ------ - -------V ----- Address ------------------- ---- ----- _( G h_1 le-��-_. City _ / _�------------------------------------------- Contractor's Name .-------- --- ------ v -------- -------------------License # -f-�,9-_{-°ZPhone .-- ----------------------- Installation will serve: Residence partment House°❑ Commercial ❑Trailer Court ,r Motel [I Other Number of living units:_________ Number of bedrooms _______Garbo e Grinder /Y_C _ Lot Size _� __ �-a__ _____________ Water Supply: Public System and name ------ - _ - - nPrivate F-1------------------ Character of soil to a depth of 3 feet: Sand'❑ Silt f] Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ 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 fx] SEPTIC TANK f Size----_-�1-Y_�'/-- _157 ------------- Liquid Depth ---------o?-_------------ Capacity --(3©_6______-- Type�� Material__ 011C eld_ r o. Compartments ------------------- Distance __ZaDistance to nearest: Well ______"'774�0 --------------------------Foundation - ---------- Prop. Line ----6-----•-•-•----- LEACHING LINE [fi No. of Lines --------- -__-_- Length of each line._-`7.�`}''��- Total Length ,_J�ST__'________ 'D' Box o__ Type Filter Material I/�__ __ G/Depth Filter Material __ �___ _______________________________ S, Distance to nearest: We!! ___" "------------- Foundation ---I- __�.__�_ _ roperty Line . �� __.___. SEEPAGE PIT [x] Depth --_g.! Diemetr'r CNumber _ _ __ Rock Filled Yes iA 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) ---------------------------•- -----------------------=------------------------------- ----------------------------- ---- ---------- --------------- ----------------------------------------------------------------------- ;----------------- ----------------------------------------------------- =------------------------ ------------------------ ---------- -------------------- - -------------------------------------- 1 11 -------------------------------------------------------------- r (Draw existing and required addition on reverse side) a �I herebycern that have ' certify prepared this application and that the work will be done in accordance with Son 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: e "l 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 su Kett to Workman's Compensation laws of California."- ! Signed -- ---------- Owner By ------------- ---- ;"' Title ------- -- (If other th owner) ----------------- [�.O f1� . FOR DEPAttTMENT USE ONLY :'." APPLICATION ACCEPTED BY ------- -- ----- DATE - ----------- ------------------------ ------------------ BUILDING PERMIT ISSUED DATE ----------------- ADDITIONAL COMMENTS -------------------------------------- ---- _ �._ -------------------- ---------------------------------------- --------------------- - ------- Y --- ----------- --------------------------------------------- -------------------- .-------------- --- --------------------------------------------------------------------------------------------------------------- - - ---------------------------------------------------------- ------------------------ - / - --------- (O -_ ------------------- Final inspection by: A--------------------.Date g SAN JOAQUIN LOCAL EALTH DISTRICT E, H. 9 1-'68 Rev. 5M Le