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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT o - --------- ----------- 3� (Complete in Triplicate) Permit No. ---- ---------- ----------------, ----------- ------ Date Issued ..- -,3e_773 _._.;____.______________________________--------------- This Permit Expires 1 Year From 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 ° ~- - r- - --- ------- -- --------- CEN SUS TRACT . ___ --- --------------- -C�-- ----- -------- ----- ----Phoneff �_ - _ - -r Owner's Name - '________ Address ---- -- .. City _ crc- C� .F------------------ ------ Contractor's Name __- - �- --- _____ _�_____�___ License #- _7/-7 rf--- Pho e �-•-- l Installation will serve: Residence (Apartment House-[] Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:______ Number of bedrooms ________Garbage Grinder _ Lot Size _.__-_ _�� -____....... Water Supply: Public System and name ----1 _____-C�-_,�_____ ______-_____-.Private Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe X 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,) �-� � PACKAGE TREATMENT f ] SEPTIC TANK [,Id' Size_Ad_-�'�__X___________-______._ Liquid Depth ______________________ Capacity 1?w_6*1_._ Type 10,1"4 -- Material____r No. Compartments _ ----- --- Distance to nearest: Well ---� ______ -------------- -----Foundation -- --- -�-_-___ Prop. Line --••-`-------- LEACHING LINE No. of Lines -----------Z--------- Length of each line....../o- -_ g �'a - --�------ Total Length ---�------------------- a 'D' Box ----/---- Type Filter Material -------Depth Filter Material __/�`?__------------------------------- k ti/ .Distance to nearest: Well _____e�= _____ Foundation __._lo_�________ Property Line .__�................. SEEPAGE PIT [ Depth ___N -_____ Diameter ___�Zj------ Number ---------�_ 0 ____________ Rock Filled Yes No Water Table Depth ----------19-----------------------------Rock-Size --------v2-------------------- Distance to nearest: Well _____ ----- Au----------Foundation -._lQ ------ Prop. Line ......... y REPAIR/ADDITION{Prev. Sanitation Permit# ------------------------------------------- Date ---------------------------------_} SepticTank (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 i 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 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 ' ¢ t BY -ly �r4.�. ------------------------- Title .. - -------------------- (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t ---- ---------- --- ----------------------------- DATE ----------.. BUILDING PERMIT ISSUED ---------------- -----DATE ------------------------------------------- ADDITIONALCOMMENTS ---------------------------------- -------------------------------------------------------------------=--------------- ------ ' --------------------------------------------- ---------------------------------------------------- -------------------- ---- --------------- --------------------------�-s-------------------------------• ----------- r t 7_ 3---_---�Inspection by. -Final -------- SAN JOAQUIN..LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M