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/0 q-:-; 9 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -- - --- --- Permit No. ----73-- _. (Complete in Triplicate) " __ --------------_-----------_. This Permit Expires 1 Year From Date Issued Date Issued ------------------ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 1I [` ' f'4+s �j -�y CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION- .__1��c�"" -- - -� - - �- �.--�'-1- - - =��---�- Owner's Name ---------------•--------------------- --------- Phone f City --- -- Address es 7------- --------- ------------------- Contractor's Name ---'------------------------------------------------------------------•License # ---------:-------------- Phone ---------------------------•-- Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other)?4 � - Number of living units------------- Number of bedrooms ------------Garba-ge Grinder ------------ e __-_- Lot Siz ---------------- --- Water Supply: Public System and name ----------------------------- --------------- ------------------------------- ---------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peaty] Sandy Loom ill Clay Loam ❑ Hardpan ❑ Adobe.F-1 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,) .�` Q PACKAGE TREATMENT I ] SEPTIC TANK' Size______}_ _ `� -------------------------- Liquid Depth �__ __________..._-- Capacity Z.7-0-0------ Type r --- Material__�`-�_'_p'`'�-------- No. Compartments __fir______________ O Distance to nearest: Well -_70____________________________Foundation __/.______---_______ Prop. Line __,&7_-------------- LEACHING LINE P�j No. of Lines ___,2- Length of each line____.�'Q__-_____-.___ Total Length ��-0--_______________ Len p 'D' Box �.---- Type Filter Material _l_,1 ---------Depth Filter Material _fl_° ---------.-------________________ Distance to nearest: Well 41V----------------- Foundation _10----------------- Property Line _._..._____...--_ ' SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number __.------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------ -----------------------------------------Rock Size -------------------------------- Distance to nearest. Well ________________________________________Foundation --------------- ---- Prop. Line _---______....._____-- REPAIR/ADDITION(Prev. Sanitation Permit# .------------------------------------------- Date ----------------------------------) ps Septic Tank (Specify Requirements) - ----------------------------------------------------------------- -------------- --------------------------------- ----------------------- _ - Disposal Field (Specify Requirements) --------------- --------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- - - - ------------------------------------------------------------------------------------------------------------------------- (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, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performs The work for which this permit is issued, I shall not employ any person in such manner as to bec a best ork osation laws of California." Signed -- -------------`-'" ------------------------------------- Owner By ------------------------------------------------------ ------ ------------------------------ ----------- -Title --------------------------------------- -------------------------------- - (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 'r _ --------------------------------------------------------------• DATE .f - ----------------- BUILDINGPERMIT ISSUED ------------------- -- ------------------------ ------------------ ----------------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------- --- ----------------------------- ---------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ -------------------------------------------------------------------------------------------------------------------------------------- F _________________________________________ __ ____-_ ---------- _ _ Final Inspection by: ----- ----------------------------Date ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT F H 9 1-'68 Rev. 5M `"