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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------------- (Complete in Triplicate) - Permit No. ---------- 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 Regulations. JOB ADDRESS/LOCATION 1,0Q' -- 1-- - ----------------------- ----------------- CENSUS TRACT I------*- •------------ Owner's Name ------A_oA_,_e _) -T------------ ---------------------------------------Phone !- Address ----------------- . ------ _4--- ------.--------------------------- Cit Contractor's Name l --------------------------------------------License # a�1�- 91Phone -70 Installation will serve: Residence 0 Apartment,Hou.se_❑.Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------------------- y�� 3 Number of living units:.__.------- Number of bedrooms _.,...Garbage Grinder ------------ Lot Size ...124 [-_��______________ Water Supply: Public System and name ----------------------------- ---------------------------------------------------+----•---------------------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 ____________________________ _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) \ I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACIJkGE TREATMENT' [ ] SEPTIC TANK:X ze / j ----�---- �1 Si4 � --- Liquid Depth -------�� Capacity _/9W.:------ Type --_ -- ,-------- Material_4 __ 'No. Compartments --.-.--.-.. �* Distance to nearest. Well ------------------------------------Foundation ---------------------- Prop. Line ___-______________ / ---- r LEACHING LINE (� No. of Lines --------- _=_.`__"-'Length of each line-----------(5�O /__ Total Length - /--��.�..... // 'D' Box �_,_._ Type Filter Material ______ �� _Depth Filter Material --__-._f_ ____________________________ � , i f10 Distance to nearest: Well ____4_�-------- Foundation ----_ .� , Property Line _____©�___--__-_ SE c@ PIT pQf Depth _.____ ________ Diameter Q-- Number _______._ _____f Rock Filled Yes Q9 No �3 Water Table Depth -__�7 �'�------------------------ `f --Rock Size ------r=� -------------p ., Distance to nearest: Well __t____�f �__/______________Foundation.____ _G__�__ Pro Line ...� ........... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ------__;_,_._-____-______________} Septic Tank (Specify Requirements) ------------------- ��rJ - -------- - posal Field (Specify Requirements) --------- Q -------- ----- ;Y1�-'----------- is r + ' Ir (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, Sate 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 --- -------- J - ----------------- -Title ------- (If other than owner[ ly ? FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ----- - -- ".__~' -- --- --------------------- DATE ------ BUILDING PERMIT ISSUED ---------------------------------------------- -------------------------------------------------- DATE ----------------------------------------- ADDITIONALCOMMENTS -------------------------------------------------------------------.-.---------------------------------------- ------------------. ,_._. x - ----------------------------------------------- ---------------------------- --- --------- - -- ------------------------------------------------ ----- Final Inspection b ---------------------------Date -------------- ---� --- SAN JOA U1N LOCAL HEALTH DISTRICT E. H. 9' 1-'68 Rev. 5M