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FOR OFFICE'USE: TION FOR SANITATION PERMIT Z APPLICATION Permit No. _7-1.--------------� = -------- -------------- -- ---- (Complete in Triplicate) This Permit Expires 1 Year From Date Issued __ -_"___-_ p Date issued ____ -------------- {. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein �. de cribed. This application is made,in compliance with County Ordinance No. 549 and existing Rules and Regulations.. ----CENSUS TRACT ........... JOB ADDRESS/LOCATION ----------- ---------- .----------- & - ----------- ------ Owner`s Name ---- --- - --------------------------------------------� -------- ----- �,. Address ---- ----------'I- 3 ? - I------- ------------------------------------.------- City Contractor's Name __.__ ---- _�----..... --...s--- ----------------------------------------------- License # - : Phone ------------------------------ Installation will serve: Residence Fr] Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ------------------------------------------•- -------------- "---- --- Number of living units: ----------- Number of bedrooms _ _______Garbage Grinder _____.-_____ Lot Size ------------------ i _______.____Private ❑ Water Supply: Public System and name ___------------------ ------------------------------- Character of soil to a depth of 3 feet: Sand❑ Silt DClay ❑ 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 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) !f y>r �``* Liquid De th ��---- •------•--- PACKAGE TREATMENT ] SEPTIC TANK [�] Size____--""-""----------•---------- q p p ---�-------------- Capacity --•--- -""- Capacity 4_.�--------- Type = ' Material__ -------- v o. Compartments14 I Distance to nearest: Wel! --- �`--- -------------------Foundation -------------- -- -- Prop. Line _ ------•=-------- ------- ------- ------ Total Length •----•----------- � 1 -_--- -_""--- Length of each line-_�� ---"""--- LEACHING LINE ttj No. of Lines _-- -'�- g f a 'D' Box "---- Type Filter Material "--- --.-----Depth Filter Material _" ' ' foundation �+ Property Line ---------------•-------- Distance to nearest: Well _ A "-"'�--- �______ Number Rock Filled Yes--t No i❑ Depth '. Diameter � ------------------- SEEPAGE PIT #1 p --- Water Table Depth __'1� 7 Rock Size ------------------------------- lr�� Foundation /� - Prop. Line -- '�-------•- -/ �- - to nearest: Well - REPAIR/ADDITION(Peev. Sanitation Permit# -------- ---------------- ' ----------------------------------- Date --------------------------------- > ------•---------------------------,<_---------------- Septic Tank (Specify Requirements) __________________ --------------------------------------------------------Disposal Field (Specify Requirements) ----------------------------•--- ------------------------------ ---------------------------------------------------------------------- ---- ---------------- ------------------------------------- ----------- ---- - -------------------------------------------------------=-------------------------------------------------------- �- :. ► (Draw existing-and_required addition an reverse side) I hereby certify that I have preparedRules and application and that the work will be Regulati the San Joaquin Local Health istrctnFlome 'tsowner or llicen- sed � this en- nd County Ordinances, State Laws, a sed agents signature certifies the following: > "I certify that in the erformance of t e work. o which this permit is issued, t shall not employ any person in such manner as to b c me subjec to W? an's C InpeW n laws of California." Owner Sign _ . 1� �-- -- ------------------------- - ---- f 1 Title - - - ---------- - - ----------------- (If other than owner) FOR DEPARTMENT USE ONLY DATE __' --------------- APPLICATION ACCEPTED BY "_.""----- -------------------------------------------------------> - --- ------- --�---- ------- --------- -------------DATE __. --- ---- ------------------------------ BUILDING PERMIT ISSUED ----"" ADDITIONAL COMMENTS p ------------------------------------------------------------------------------------------------------ --------------------------------------- ------------------------ --------------------------------------------------------------------------------------------------------------------------- + •---------- ----------- ---------- ------------------------------------------ i _ Date Final Inspection by: ------ SAN JOAQUIN LOCAL HEALTH DISTRICT F H 9 1-'66 Rev. 5M /-7- f%. -