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FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT 1 y __ --=--------•-------- ---- Permit No: � lc• - —...�.., ...... -- (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued/a_ �_`"f"_73 -------------- _ _ --------------------- ---------,- ---- 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 4_-�9-x------ dam' - ---- -------- ---------------------------------CENSUS TRACT -------------------------- Owner's Name ----- -�,ppYl-------- ------------------------------------------------ Phone --•---- Address :----.. ------ '------, ,.�..66�-- ---- ------------ ----- -------- City --------- ------- ------ - ---- �on-------------------------------------- Contractor's Name __: __ ______r_-- License # W#)9Phone Installation will serve: Residence 2 Apartment House❑ Commercial :❑Trailer Court ;❑ r Motel ❑ Other -------------------------------- -- -- Number of living units-----/------ Number of bedrooms ____- __Garbage Grinder -------- --- Lot Size ___ _d__' ��'� r Water Supply: Public System and name ------------------------------------------- ---------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam M Hardpan ❑ Adobe.X Fill Material ------------ If yes, type -------_____________________ (Plot plan, showing size. of lot, location of system in relation to wells, buildings, etc.T must be placed on reverse side.) 4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT { ] SEPTIC TANK f l Size-----------------------------------•.----------- Liquid Depth ----------------------_- Capacity __.----------------- --------------------_____Ca acit Type ____________________ Material---------------------- No. Compartments -------____ i-� Distance t6"nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- -LEACHING --------- -_-.-."LEACHING LINE j' ] No. of Lines --------------------r--- Length of each line---------------------------- Total Length ______--___-_______________- _1 F D' 13ax ------------ TypeFilter Material --------------------Depth Filter Material ________________---.---------_________------ N Distance to nearest: Well.-;------------------------- Foundation ________________________ Property Line ___-______________-_--__ SEEPAGE PIT Depth ____ c}_______ D.iameter ___ ____ Number ----------l---------------- Rock Filled Yes ® No ❑ g v . Water Table Depth --------------------------------Rock Size --------� -/ f -------------- Distance to nearest: Well ------—------------------------Foundation _____14_______ Prop. Line -----Z-0 REPAIR/ADDITION(Prev. Sanitation Permit# ---------F---------------------------------- Date ----________________-_____________) r Septic Tank (Specify Requirements) --------------------s----------- 1 -� ------. --------------------------- -fid' `' Q Disposal Field (Specify Requirements) -------------------- ------------------------------ - -----------------------V-"- ---- ----------------------- -- ----------------------------------- 3 m� ------------------ -----------------------------------------'--------------------------------------- - --------------------- --------------------------=--------- ----------------------------------------------- ------------------------------------------------------------------------------------------ ` (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 performance of the work for which this permit is issued, I shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------------------------'°-=-------------------=---------_---- -•-------- ------ Owner. ..� Title +BY -------------- (If other Jii,n,owner) T FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY ------------------------------------------------- DATE --- - �` BUILDING PERMIT ISSUED -------------------------------------- ------ --------------DATE ----------------- --------------- ADDITIONAL COMMENTS -------------------------------------------------------------- ----------------------------------------------- -----. } F ------------------- ----- --------------- --------------------------------------------- ------------------------------------------------------------------- --------------------- _ _.________________________.____ _ r___.Vo-- t _-,__ Final Inspection by: = ---------- Date LLLJJJ ------------------------- SAN,JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 T-'68 Rev. 5M