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/ FOR OFFICE USE _ ICATION FOR SANITATION PERMIT --------------- ` Permit No. l__� Y_-- (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 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/LOCATION .-- -- -J- -,- ----------------------- z� / --------------------------------CENSUS TRACT .,_--- ------------- Owner's Name ---zr Phone.� ---'------ Ci ------------------------------------------ Contractor's Name _ «'-------- ----------_ ________________License Phone Installation will serve: ResidenceXApartment House❑ Commercial:❑Trailer Court 0 Motel ❑Other-------------------------------------------- - Number of living units:______ _____ Number of bedrooms __ g 3� ' 'X �__GafbO e Grinder ____________ Lot Size ____________-__� __________________________ Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand Silt 0 Clay ❑ Peat❑ Sandy Loam ,❑ Clay Loam 0 Hardpan ❑ Adobe 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 [ ] SEPTIC TANK; Size � _ Liquid Depth ________________ ___ � ` �Capacity ------- TYpe ` __ Material_ �_____ No. Compaments _____ ---------- Distance ---- _ ._Distance -------_5- v to nearest: Well c�_±__________________Foundation /�____________ Prop. Line _S__ ----- i LEACHING LINE No. of Lines --------4------------ Length ofline____.��_1'_�''____________ Total Length -------- 'D' Box ____________ Type Filter Material _ �� Depth Filter Material ------Zee___-_____________________ Distance to nearest: Well ___ ______ Foundation ___ _// �__________ Property Line :5_!___ ' SEEPAGE PIT Depth -5 '---- Diameter 5�__P�____ Number -_______J______________ Rock Filled Yes);T'' No 0 Water Table Depth _______ _________________________________Rock Size _-�__� _________ _ ,'` rl Distance to nearest: Well __,f_A�---_______________________Foundation _/_ _-__.____ Prop. Line _�_-___________ 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 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 performan f the work for which this permit is issued, I shall not employ any person in such manner as to be"e su iect to W rkm n' Compepsa laws of California." Signed --------- - / �ti� Owner By ------------ ------------- -'r- -------- ---------- ----- -- -- ------ Title - ------------------------------------------- (If - ------------- ------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______ _ DATE _ ' ____________ ___----______ BUILDINGPERMIT ISSUED ----------------------------------- --------------------------------------------- ----------------------DATE -------------•----------------------------- ADDITIONAL COMMENTS ------------------------------------------------------ ------------------- ------ - -- i ------ ---------------------- --- ---------- ----- ----- - - - - - - - - - - - - Final Inspection by: ______ z� '. SAN JOf__ UI1N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M