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F R FICE USE:, -- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. O . ! ---------------------------------------------------------- ------------------------- This ---- Permit Expires 1 Year From Date Issued Date Issued � - E-- ©sr � f2-0 3v 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 Regula rns: �,747 3 JOB ADDRESS/LOCATION/ �'�-- .__- -,/--- <--,.C,---- ----C+ �e@ TRACT ------------------------ Owner's Name -- Phone `" __. Ci --------- Address --------- 4� F � = city Contractor's Name f l = ,(VrZ --------------------------- --------License #,5f AA'PZ---_ Installation will serve: Residence W 'A'partment House,❑ Commercial ❑Trailer Court ;O Motel ❑Other -------------- ---------------------------- Number of living units:-.-- ---- Number of bedrooms------Garbage Grinder V/1O-�P_ Lot Water Supply: Public System and name ----------------------------------------------------------------------------------------- Private( Character of soil to a depth of 3 feet: Sand bs %Silt❑ Clay ❑ Peat❑ Sandy Loam )6 Clay Loam ❑ Hardpan ❑ Adobe')] - Fill Materia ------ If yes, type--__-_______•____ �-- -. k •« (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,) r� PACKAGE TREATMENT [ ] SEPTIC TANK 10 Size_101"JeAK.'er.31y---- ------------ Liquid Depth ----------- ---- 1 CapacityPQ Type Material p --- ---- -- 1 L No. Compartments _- Distance to nearest. Well _ ----------------------- ---------------------Foundation --/��____----- Prop. Line � ---:..__. I`N LEACHING LINE � No. of Lines -----�-_--___-_-_- Length of each line ---------- Total Length i 'D' Box/,C_!F Type Filter Material —Depth Filter Material _-14P-------------------._-_'_-_-_... Distance to nearest: Well =- --------------- Foundation -----________ Property Line. ___t?-'_________ SEEPAGE PIT Depth ---- Diameter _ - -___ Number '__2------__ __--__. Rock Filled Yes ,j No i❑ Water Table Depth -------7,9-l------------------------------Rock Size -------------- Distance ----------Distance to nearest: Well ..11�-----------------------Foundation ` -— Prop.11 Line ----4_...... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------------------- Disposal Field (Specify Requirements) -------------------------•------------------------- '-------- ---- ---------- --------------------------------------------------=---------------------•-- F (Draw existing and-�egiredaddition 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 dadquin Local Health District. Home owner or licen- sed agents signature ceitifies the following: ! "I certify that in the: er I performance of the work for which this pt is,is;ued,`I shall not employ any person in such manner as to become subject to,Workman's Compensation laws of California." 4 •' 1*- s . Signed --------------- ---- ------ -----------. .. '- - -----------------i '.Owner Title ---- -- -------------------------------- --- - - ------------- - BY t ` than erowner) '" ._.o...r. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - -- _ e F a - DATE - d` - ---------- BUILDING PERMIT ISSUED -------------------------------- --DATE ------------------------------------------- ADDITIONAL ------------------------ --ADDITIONAL COMMENTS ---}-------- ------------------------------------------------- ---------------------`- $-------- --------------------------------- --;------ ------------------ - y -------------------- ----------------------------- - -- ------------- --- ------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ------- ---------------------------------------- ------ -- ---------------------------- - - - - Final Inspection by: __ - Date .- - -- -- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M, r ti`` • ,�,