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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y"'✓ _7d a'�� Permit No: 7v_-- __. ------------ - ------------------- --- {Complete in Triplicate) ------ ��7d --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued -_-_ __`--__-____ 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 Ordin nce o.-549 and a isting Rules and Regulations: '�l�?7 7 S � f•c cel�4.,a-,�.n��J ------------ JOB ADDRESS/LOCATION - ---------- CENSUS TRACT Owner's Name ---- - -------------- = Phone 7I__� /-73------- - Addres's ---- - ----- ---------- -------------- ---------------- City ------------------ - ------ -- I Contractor's Name L __� __,___ � - -----------------License# �, ---__ Phone Installation will serve: Residence ❑Apartment House ❑ Commercialorailer Court l❑ Motel ❑ Other ` Number of living units------------- Number of bedrdoms ------------Garbage Grinder ------------ Lot Sizei!� - --------------- I _ i Water Supply: Public System and name ----------------------------------------------------------------------- ---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ 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 side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT [ ) SEPTIC TA�NK Size1.--� I`-- ______________ Liquid Depth 7".-------•---- l /� _ e�.r.��a�.� C Capacity Typ ----------- - - Material- -- - -------___--- No. Compartments --__a�----- -. • I � r Distance .to nearest: Well __Z -___�______________Fouundatio/nnA:�______________ Prop. Line LEACHING LINE No. of Lines C -- Length of each line_LO (p D_ Total Length __l�Q_......... 'D' Box ;s_I___._ Type Filter Material _57.- - - �- e th Filter Material _.__/_ -,--________________________`. ( I yP P [ Distance to nearest: Well/A0__'_'1 ____- Foundation _P- -- --------- Property Line. . __ SEEPAGE PIT [ ] Depth ________________ Diameter ---------------- Number ------ - Rock Filled Yes ❑ No 1❑ WaterTable Depth ------ ----------------------------------------Rock Size -------------------------------- Distance to nearest: Well -------------------------------- ------Foundation -------------------- Prop. Line ................. REPAIR/ADDITION(Prev. Sanitation Permit# -------•------------------------------------ Date --------------•----------------.--1 I Septic Tank (Specify Requirements) ----------- --------------------------------------- ----------------------- ---------- - ----------.__„_----------------• [ ---------- Disposal - ------- Disposal Field (Specify Requirements) -- =--------------------------------------------------------------------------------------------------------------------------------- - - _ --- - - -° [-------------------------------------------------------- ------------------------------------------------------- -------- ---- -----------•-----_ 4 ` - i ________________________________________________ _________-__ ;.1 (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 as to b me ubiecf to or an's Compensai n laws of California.” Signed - -- ------------------ Owner I ------ Title ------ - - --------------------------------------------------------- (If oth t an owner) i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------41�_eo ---------- ---------------------------------------------------------- DATE ------- _-_'2r2------------------ BUILDING PERMIT? ISSUED ------- --`--------------------------------- --------------------------------------------------------- --DATE ------------- ----------------------------- ADDITIONALCOMMENTS --------- ---------------------- ----------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- 4 F ---------=---'------ --------------------------------------------------- ---------- ------------ ----------------- --------- --_=s� 7) _ Final lnsection by: -- ------ ---------------------------------------------- PDate -ter t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M