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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------- --------- ---;&- - -------- \\ lil� Rermit No. (Complete in Triplicate) - ----------------------------------------------- 40S,� r2 ---------------------------------------------------------_--------------------------------------------------------- --------------------------------------------------------- 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 Ordi ance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .___/_/ 4r5-6 __x_�__:"" = -C _ ---- ------------------------------CENSUS TRACT -------------------------- Owner's Name --------------4 l_zl - ------------------------------------------ / -- Phone - � s�'�------ Address �� ,—✓ '„ t7 X11 = lrrE - - - . City ----- - Contractor's Name -------------------- L------------------- License # ------ --------------- Phone ------------------------ Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ;(�l/'/`� "2- Motel ❑Other ------------------------------------------- Number of living units:--------�--- Number of bedrooms ---- -.....Garbage Grinder ___________ Lot Size ____ _ :---------------___-- Water Supply: Public System and name ------------------------------------------------------------------------------------------------------------.--Private [ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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:X Size___ __. X_ ________________ Liquid Depth Capacity 42Z754`A;Type __S.B G Material__________________ No. Compartments - — ------------- Distance to nearest: Well ________ ___________________Foundation)__/<l-___f"____ Prop. Line __._ -f`_--. LEACHING LINE K No. of Lines ------- ___ ____ Length of each line_______dl_-�_____________ Total Length ___A 1_ ..___.___.__._ 'D' Box ----j------ Type Filter Material�Y' &X4�ADepth Filter Material ---------- ___________ Distance to nearest: Well ------ __.f"___ Foundation ____le) ___ Property Line ------ ...-l5=...... SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number ---------------------------. Rock Filled Yes '❑ No (3 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well _____________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------------------------- ----------------- --- ----------------------- - Disposal Field (Specify Requirements) __________________ 'I_QI_ "___ 8" - -- - -- - � ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ------------------------ - ------ ---- --------------------------------------------------------------------------------------- (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 ! the ormance of the work for which this permit is issued, I shall not employ any person in such manner as to becorpe ubjec 1 Workman's C mpens ion law of California." Signed -�j Owner l By ---------- ----------- ---------- ------------------------------------------------------------------ Title ---------------- ------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __.--------- __________________ DATE ______ -------- BUILDING PERMIT ISSUED --------------------------------------- --------------DATE --------------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------------- ----------------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------- ------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ------------------------------------- -- - - ---------------------------- --------------------------------------------------------------- - _ Final Inspection by: ----- --- e- -------- -- ----------------------------------------------------Date -- -- r� SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M