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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ._7� ----- ---------------- -------"------------- (Complete in Triplicate) - ----------------------------- - Date issued - 314Q17.2_) This Permit Expires I Year From.Date Issued ---------- --- " 1 Y`0.i fL'r 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. l f ----.CENSUS TRACT ----------------------- JOB ADDRESS/LOCATION �- --/�.�1_f',� __�=�'�- - -- - - ------ ------------ i _ -- ---Phone -------------------•---------------- Owner's Name ----- ~- �'` --------- ------------ : ' /fie'------------ ----------- City - Phone Contractor's Name ---- --------- �-r, e--��-- ------------- ---------- -------------License # ' Installation will serve: Residence [D Apartment Ho se'[] Commercial []Trailer Court ;(] Motel Other --. Ale--- !/» --- 6z-a e�-�_-----`-- Number of living units:_ - Number of bedrooms ------------Garbage Grinder _.__ Lot Size -"---- - Water Supply: Public System and name ------------ - _____________________I-_____________ Private [�_ Character of soil to a depth of 3 feet: Sand'1] Silt C] Clay ❑ Peat El Sandy Loam Clay Loam .o e � 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.) iv NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 2d0 feet,} r„ PACKAGE TREATMENT SEPTIC-TANK{ ] Size------------------_-- ----------------------- Liquid Depth --------=--------.--- No. Compartments _.___-__2I......... Capacity�� -G�'�`---- Type Material__C �z _ l/ 11 Distance to nearest: Well --------•9 _'l-----------------Foundation ...�� °------ Prop. Line _-___ ------- LEACHING LINE No. of Lines _________ _ __ _ _____ Length of each line._.___" Q <._----- Total Length ._.-_/ - a Depth Filter Material _____1q------------------ ------------- i D' Box .__ ----- 7yp Filter Material p �� t ----__-- Property Line ._ Cr- -- Distance to nearest: Well _.----J ----- Foundation SEEPAGE PIT [ ] Depth Diameter ---------------- Number ---------------------- ----- Rock Filled Yes ❑ No 0 Water Table Depth ------------------ _Rock Size -------------------------------- Distance to nearest: Well ___.__-____-------_- -------Foundation ____________________ Prop. Line .-_____.__---..------- I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements ----------- ----------------------------------------------- _"___________________"______--.___-- - Disposal Field (Specify Requirements) --------------- ------------------------------------------------- ' - --------------------------------- ------------------------ ------------------------------------------------------------------------------- ---------- ------------ ------------------------------ -'--------------------------------------------------------------- ! (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 shall not employ any person in such manner tas to become subject to Workman's Compensation laws of California." Signed ----------------- -- Owner - --------- - --------- -- ------------------------------------------------ i�!(1/L,�c_4 - --------- -------------------------------------- BY - - - --- -- ------- ---------------- -------------- ----- Title (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- --I- _.----_. DATE - ---_3 -------------------------------------------------------------------- F BUILDING PERMIT ISSUED ------------------------ --------------------------- -------DATE i ADDITIONAL COMMENTS ------------:--- -----------------------= 3 ----- - - Date -- -------------- - �'-------- • ----- -------------- Final Inspection by: ------ ------------ ---------- 5AN JOA0UIN LOCAL HEALTH DISTRICT E. H. 9 1-:68 'Rev: 5M