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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r ....... - Permit No.;7z�lQa9 (Complete in Triplicate) _.. ....................------------•. ..__._.............. Date Issued ............................•--_..._....._.._.........,__ This Permit Expires 1.Year from Dat*Issued ode to the San Joaquin Local Health District for a permit to construct and install the work herein Application is hereby m q described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ,.- ...... _ . . . . :.............. CENSUS TRACT/.. _rr------ Owner's Name .......................................... ....•......Phone . l0 '.7 ,1••-- Address - ..-.. City Q �.......Ph..._... � ................ ........ as��i Contractor's Name Name fL �_._. .........-License #�............... one r Installation will serve: s ResidenceApartment House{] Commercial ❑Trailer Court ] Motel ❑Other . Number of living units:--<---------Number of bedrooms _...3......Garbage Grinder Lot Size ................. � Water Supply: Public System and name ..................-----------•--.....................................................:.-........................Private Q_ i Character of soil to a depth of 3 feet: Sond 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam, Hardpan_❑...5.,..Adobe 0—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 208 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size-•.............................................. Liquid Depth _........ ................ I\ , w Capacity ---•----------•-•--- Type .................... Material-----------=---------- No. Compartments ........., ......... U ............ ..•---- _..._ .....Foundation _._..... ............ Prop. Line .............---...... �'. LEACHING LINE [ ] NoDistance nearest:Well of Lines --- Length of each line.---•........................ Total Length ............................ 'D' Box ............ Type Filter Material ....................-Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation ' ._........--- .......... Property Line ........................ SEEPAGE PIT ( ] Depth ...-__------------ Diameter ................ :Number ---------------:............. Rock Filled Yes ❑ No Water Table Depth ----------------- ------•-- -----------......Rock'Size ••--= .........._........... Distance to nearest: Well ..............•..................•__-.._Foundation .................... Prop. lin® .....'......_..._y.. ....... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------_--------_--------- Septic ---•---_- .Septic Tank (Specify Requirements) ...-.---- - --•--- ..... . ...... .......... ... ------ - ... - .- EF. ... .............-cl Disposal Field (specify Requirements) _______ ._ ------- .• - ------- - ._.._...�6... .. ----------------------------•--------•--------------- ----------._.-._---------------------- -• --_------•-------- ------------------- ---•-•----------_____------•---....------------.......------ ---------------------- --------.-----------------------------------------------------------------•------------------------------------------------------------- -._•-•..-.. -••-•---....-.- F (Draw existing and required addition on reverse side) - _. "�_r►�` I hereby certify that 1 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 Of licen- sed agents signature certifies the fallowing: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workman' Compensation laws of California." Signed Owner ----------- --•-- .--•-••------• ---------- Title .-.. Ate- ........ -------------- ---------- r than owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED 8Y _. ----------- --- - DATE --_• -.� - - -- -..._ BUILDING PERMIT ISSUED ------•----- -_------------------ ADDITIONAL •----------•- •-ADDITIONAL COMMENTS ------ ••-•-- ---------•-•--•- -.------------------------------------------------•--•-=------•.....-----..___..- ------ •-•-- --------------- ---------------------------------•--- rte- v Date -- ...'. Final Inspection b " f EH 13 24 1-68 &v. 94 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M