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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT t- Permit No: ------ --------- --------- ------ ----- {complete in Triplicate} ----------------------- --------------------------------------------- Date Issued x This Permit Expires 1 Year From Date Issued ------------------- Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT c�-'"_.-'T --------- JOB --- -� -.-- JOB ADDRESS/LOCATION _210!73-----�:- p -----------Phone. Owner's Name ifl � �..1� --------- r = - x"�------------------ Address ------------------ _1 Q.�2.7 / f !3_R>-----------•--._.. CitY1 _ !-�t_ ,= /�"E� -- - ------.License# =-------------- ----- Phone ------------------------ { Contractor's Name ----�� ---------- ------------- ---------------- - - Installation will serve: Residence ❑Apartment House C] Commercial:❑Trailer r Motel ❑Other --------------------------- ----- Number of living units;___------ NumOo r of bedrooms _- Garbage Grinder - ----- Lot Size _ _ __ - _: yy 4 - 1 0. ,Water Supply: PublicSystem and.I . .--,.t_________ ____ __ _ - Private - Character of soil to a depth of 3 feet: ,Sand'❑ Silt 0 Clay ❑ Peat❑ Sandy Loam Clay Loam ;❑ Hardpan K 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 ublic sewer is;aa-voiilla�ble within 200 flet,) I PACKAGE TREATMENT ] SEPTIC TANK Size___-` -,/O----- ��---------- Liquid Depth ..� Y^-• j1 �� _ �- Capacity/Z0.0---- Type ,1_ 0 Material�1� No. Compartments ------ __---- ---Foundation.' O_"�------.Prop:Line ._ Distance to nearest: Well "____-_ �-- -- { Length of each line__.__ _. ___------- Total Lengthr__ ---.•.--------- LEACHING LINE No. of Lines ----__1-------------- g AA/r D' Box A66---- TYPe Filter Material K_Q_C _De th Filter`Ma#erial-_--- _-- ----.------•---•- �~ pf Pro e ' tine. �l Rock F'll V{ " Distance to nearest: Well -------50 Foundation _ p � SEEPAGE PIT Depth l._ -- -� - Diameter --X.2S_ Number - ----� -.-- r- Filled Yes No I❑ Water Table Depth f Q - Rock Size ' n j.:Foundatian __� ----- ---- Prop. Line __-S.............. Distance to nearest: Well � �/-------- - t sl , I REPAIR/ADDITION(Prev. Sanitation Permit# ------------------{ --- -----------------�, Date -------------- 1 Septic Tank (Specify Requirements) ----------------------------------------------------------- ----------- ---------------------- -- - - 1 - i. Disposal Field (Specify Requirements) ----------------------------------------------- I ; k ----- -- - ----- -- --------------------------------- ---------- ------------- - ----------------- -- - _ x -- ---------------------------- -----------------------------------------------------------------------------------------------------------------_-___--------___--_----_---_-_.-_--.--_---__.-___--.--_________ (Draw existing and required addition on reverse side) 'tz 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 signator certifies the f lowing: I p p person in such manner "I certify th in perfor n of the work r which this ermit is issued, 1 shall nof—e Iby any as to b jest to�'7dH( n's Co a tion laws of California." Signe r ------------------------ Owner - ---------------- - - - -- --- - ------------- By - -_----- ------- ---------------------tt_R--C7_-title (If other than owner) FOR DEPARTMENT USE ONLY e� ---------------------------------------------- DATE ---- —` '�*� ---- ---- APPLICATION ACCEPTED BY __-__-__ `-1- - ----------------------- BUILDING PERMIT-ISSUED --------=------ _- DATE »- ADDITIONAL COMMENTS _._ -------------------------- ------------------------------- - ' ---------------------------- ---- -- - - - ------------ - - - ----- ---- /. .._ ---- ---- ------------------------------- - -- -- --- -- -- ---------------- --- --------- ------- -- _ __ __ _ ------------------------------------- Final lnsp ----Date --- ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M r a