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�ar FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------- r---------- . ... _. _ Permit No. . (Complete in Triplicate) `— �� 1 ' This Permit Expires 1 Year From Date issued Date Issued --------------------------------------- ----- Application is hereby made to the San oaquin Local Health District for a permit to construct and install the work herein described. This application is/mc Ae in mp�liionce'with CountyOrdinanceNo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .--" - --�(C/- -t --- 3-/-------------------------------------------CENSUS TRACT -------------------------- Owner.s ----• -_.Owner's Name A Phone = ---- -- Address x:/l�_ , ` -----.................. Cites Contractor's Name ----- - -----------License # ------------------------ Phone ----a-- .............. Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ----------- I------------------------------- Number of living units_____________ Number of bedrooms _ Garbage -Grinder ------------ Lot Size _ _ __� ------------ Water Supply: Public System and name ---- � - ;, Private 1-1 Character of soil to a depth of 3 feet: Sand❑ Silt El Clay 11 Peat Sandy Loam ❑ Clay Loam 2�_ - Hardpan ❑ Adobe'E) 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 seep ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ 3 SEPTIC TANK Size______. __ _________________,___ Liquid Depth :•___._�1��,...t Capacity �.ZG-o_..._ Type r 0--- Material__ ___� _$.,__- No. rCompartments =___`? ..f... Distance to ..nearest: Well' _______- 1___r_.________'__Foundation - _(j____________ Prop. Line __________ ..._ LEACHING LINE, w �No. of Lines -------�[------------ g �� a--- _ -- ------ ------ Total Length .-- /_('__{J------------ 101' ---------- Y Length of ach lin �._ t: / ri D' Box ._ —Type Filter Material _�_y?%_____Z_Depth Filter Material -----_ ___�_ ___________________________ Distance to nearest: Well _�__. -___.-__ Foundation _.:___. _�_.r_____ Property Line ____"No ! .:.___ `�' SEEPAGE PIT .�[ Depth _._ 2_=_ �_rDiameter �__,�-:�,2 Numher_________../__________ __ Rock Filled Yes I❑ Water Table ------------------------------------ Depth `4Rock Size _- = Distance to nearest: Well ___ ______ ___ ______-__-_____f_Foundation __._. _( -_'____;Prop. Line ______5______________ � REPAIR/ADDITION(Prev. Sanitation Permit 51# -------------------------------------------- Date --------------------------------- Septic Tank (Specify Requirements) _________._____ ._k_ } `+ ---------------------------------___________________________________________________________ i Disposal Field (Specify Requirements) i �________________________________________ I A— 4 k I ; ---------------------------------------------------------------------------------------------I---------------------------------------------------------------------- ------------------------------------- 1 (Draw existing and required addition on reverse side) .1 I hereby certify that I have prepared this application and that the work will be done in accordancewith 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 stroll not employ any person in such manner as tobec su ct t Work oMpensation laws of California." i. a Signed ------------ Owners ✓ t BY ----------------- ----- ----- ---------------- Title .... ---- ----------------------------------------------- (lf other than owner)' £ FOR . RTMENT USE ONLY APPLICATION ACCEPTED BY ----- --- _ - _ _ --- - DATE __ ------- BUILDING PERMIT ISSUED ------- -- - - --------_.__-DATE ------------------------------------------- ------ ADDITIONAL COMMENTS --- --- ___'_ _ - --------------------------------------------- ----- ----r --- - --- . L t M { Final Inspection by � ` "______Date I------- _YS - -------- JOAQUIN LOCAL-HEALTH DISTRICT i E.-H:.9 1-'68 Rev. 5M