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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: -7.Z • (Complete in Triplicate) ��rr ., r Date Issued This Permit Expires 1 Year from Date issue 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 complianceSwitkA-Ie�t^ Ordinance ce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION - ;--- �SC� ----- -�------------ - CENSUS TRACT •� -----------------Phone ,Owner's.Name Av--------- �----------- . - ---------- a_I Address----��I- - �,o�--------------- --------------------------- --- ------------------- - City - �� .. License #1-Z2,-,6y3- -- Phone Contractor's Name _. Installation will serve: Residence Apartment House❑ mmercial ❑Trailer Court ;❑ Motel ❑ Other ---------------- r r g V--- Lot Size ---Y- -------------- Number of living units:---- Number of bedrooms --,2------Garbo e Grinder YPrivate [IWater Supply: Public System an name -_____--------------------------•---- -------------------------------- Character of soil to a depth of 3 feet: Sand'0 "Silt E] Clay ❑,f. Peat El Sandy Loam -E1Cla Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _---------- If yes,type --------------------- -- f; (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 --��f----------- Capacity� —--------- Type MaterialL`�� No. Compartments '� Nk -- ---- --------Foundation -- - -------------- Distance -------=-- Prop. Line _ :�..: Distance to nearest: Well _ F r / :------ - No. of Lines - Length of each line____ ------,----- Total Length ,•T LEACHING LINE jef] --- --. ;>.....- f r F e Filt i 'D' Boxx _ -- Typ er Material,rl 0 ___.Depth Filter Material -I -- , Foundation r ------------ Pioperty Line -- ~----- 1 Distance to nearest: Well,�_-�--�---- � ------ SEEPAGE PIT [ ] Depth _ Diameter -----. Number _____ ..______________ ---- Rock Filled Yes ❑ No.0 ------------------- i Water Table Depth Rack Size ---- Pro Line ----------'--- .Distance to nearest: Well --------------------- ------------_Foundation -------------------- p ------- REPAIR/ADDITION(Prev. Sanitation PermGt# _-------. -------------------- - ---- ------ Date ----------------•- ---------------) t } Septic Tank (Specify Requirements) --------- --------------------- ------ Disposal Field (Specify Requirements) -- ----------I------------------------------------------------ s ------------------------ ------------------------------------- -- ----------------------- ------------------ ------- --------------------------- I (Draw existing and required ad' ' clition on reverse=side) is 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: f for which this permit is issued, 1 shall not employ any person in such manner "I certify that in the performance of the work as to becomisubjec to Wor man, Compensation laws of California." Signed --------- ------------------------------------------- Owner �,�.--------------------------------------------- Title !r ---------------- - r hon owner) FPR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t------- ----- - -------------------------- ----------------------- -/ - BUILDING PERMIT ISSUED ---------------------- ---•------- ------------------------------- -------- -=------- ----- BATE -- --------- ------------------------------ ADDITIONALCOMMENTS ---------------------------------------------------- ----------------------- - --------- ------------------------------------------------- -------- ----------- ---------- -------------------------------------------------------- i"Wik— ---- ------ ---- - ---- ------ -- -------------- Date �.�/..; «. -- ------ --- Final Inspection b --- -" .l SAN JOAQUIN LOCAL HEALTH DISTRICT E H. 9 1-'68 Rev. 5M