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FOR OFFICE USE: ' µ * . ,-APPLICATION FOR SANITATION PERMIT ------- 6--------------A--- -- ti. 1-4 - .. (Complete in Triplitate) Permit No: d � �7 __ __ ______________ 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/LOCATIO ___ �� --_--__ -- ---1� �-_______. SC _ . .-CENSUS TRACT _____S_�_�� .._ Owner's Name ! / ��'_-------& �?.Q.�-�--------=- y ' : -------------Phone ��---��41- Address City -----------------------------•------ Contractor's Name------- ------------------------------------------------------License #(_----------------------- Phone Installation will serve: ry€Reiidenceo Apartment House[] Commercial❑Trailer Court i❑ Motel ❑Other ----------------- ------------------------- Number of living units:------{----- Number of bedrooms _-__, ____Garbage Grinder ------------ Lot Size .__15e ,y Q! - ------- --------------- Water Supply: Public System and name ------ - s _ f`.-e_______ _ ------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ 10eat❑ Sandy Loam ❑ Clay Loam;p?_� Hardpan Adobe ❑ Fill Material _1va__ 1f yes,type__________________________ ` (Pl'ot plan, showing size of lot, location of system in relation to we'lls,,buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep a a pit permitted if public sewer is'available within 200 feet,l PACKAGE TREATMENT { ] SEPTIC TANK [� Size-/ D X__S ------------------ Liquid Depth - --------- Capacity -120-0------ Type IPRE FI_B Material_cQW: _l=1E No. Compartments ---- Distance --Distance to nearest: -Well __J {_._ ----------- ______Foundation __ l _6__: —_ Prop. Line LEACHING LINE of Lines ------ ----------- Length of each line-__ Total Length ----- .............\D D' Box _. Type Filter Materiala�.-14:.:_-Depth 'FF7ilter Material -______._ /_!.......... ............... r r 11 f Al �. . Distance to nearest,,Well ______ _____________ Foundation __ __ -`:__-___ Property Line. ______..__.------ ------ SEEPAGE PIT Depth ._ ____ _ Diameter _ _. Number ---_-- —:______,Y___ Rock Filled Yes 2__� No 0 Water Table,Depth --___ -----------y--'--`---------------Rock Size _-/ -�__- _ 67--- r Distance to nearest: Well _____ V-0 ____"_______._____Foundation ---� ____ ___ Prop. Line _.. .__` .____ r REPAIR/ADDITION_{Prev. Sanitation Permit# ---.__.i---------------------------------------- Date __________________________________) Septic Tank {Specify Requirements) _____________________ '`•:_:__._'=f:__ --------� -- ' Disposal Field (Specify Requirements) -------------------------------------- _________ __ w - -----------------------=- -------------------------------------------------------------------------------------- ----------------------------------- ----------------------------------------- -------------------------------------------- ------------- -------------------------------------- --f.---------- (Draw existing and re wired 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 beco ubject to Wor an s C tion laws of California." Signed -------------------------------------- Owner By - -------------------------------------------------- ---------------- Title ----- -- -- ----------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- �� j ` t:_°( -----------------------------------------I - -- ---- DATE `-f-" `-7 ------------ BUILDING-PERMIT ISSUED - -- - --------- 1 f _f1 _(_-1 ---- - ----DATE '------ -----------`-=---=----- ADDITIONAL COMMENTS --------'='-------------' -= ti �• ---------- --------------------------- _ --------------------------------------------------------------------------------------------------------------------- ------- ---------------------------------------------------------------r Final Inspection by: `' Date ---- ' -fr -------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 ]-'68 Rev. 5M 1