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FOR OFFICE USE; APPLICATION 1`01 SANITATION PERMIT ------------------------------------------------- - (Complete in Triplicate) Permit No. --------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 ade in compliance with County Ordinance No, 549 and existing Rules and Regulations: AA*- 75- JOB JOB ADDRESS/LOCATION .__ i� `_T r�tr-t>wT--_/f-B-- / roiwTXAA CENSUS TRACT --------------____________ Owner's Name � --. �_----------------------------------- ----------------Phone -------- ------------------- Address --------------------- ------- -- ` _�/•FrirCD/� SGL-=---------- ------------------. City -/� ��--------- Contractor's Name -L� �t149ie1---------------------License Phone14� Dy3AP-1, Installation will serve: Residence ❑Apartment House❑ Corpmercial ❑Trailer Court ;❑ Motel ❑ Other ____ - ate_ _ - ________ Number of living units:------------ Number of bedrooms ____________Garbage Grinder __________ Lot Sze _. _ _r.__�_{___.-.____ Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peau 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,) PACKAG�EE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -------------_---------- 1 Ct51, �q Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ----------•----------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line .------------------... _- LEACHING _ _ .. LINE [ ] No. of Lines ________________________ Length of each line____._______-_------ --__-_ Total Length -_ __-___.._______ _.-_-__ irk -rrA) 'D' Box ------------ Type Filter Material ___________________Depth Filter Material --------------------.___________--._....__._ Distance to nearest: Well __._._____________--__ Foundation ------------------------ Property Line ________.__-_...__..____ t4r 4 1 SEEPAGE PIT [ ] Depth _- ------------ B�izmreter&X�--_- Number _-__----/--------/ -�- Roc kFilled Yes No 0 p Rock Size _ __ _ _ Water Table Depth .3"= ""��--,,, IX Distance to nearest: Well _____ -�G!-_ ------------ /0_____________ Prop. Line ...x.5---____ REPAIR/ADDITION(Prev. Sanitation Permit# ---------- --------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------- "----------..__..._- . ----- Dis I Field (Specify RequirementsL_---- f-----X- ' ------f/ -- -- ------ ----------------------------------------------------------------------- (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 becom ject t W rkma 's Co ensati.on laws of California." Signed ---- -- � E- Owner - -- -------- -- - - BY - Title ------------ ------------- ------------------------------ (If other th ow r) FOR DEPARTMENT USE ONLY C. 19 APPLICATION ACCEPTED BY ------- - - ------ -----=----- - - - ----------------------------------------- DATE ------ - ---- --� ---------- ----•- BUILDING PERMIT ISSUED ----------- - --------------------------------------------------------------------- --- DATE ------- ----------------------------------- ADDITIONALCOMMENTS ------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- ---------------------- ------- _ _ _ _ _ __ _ ----- t f _. �3 Final Inspection by: ------------------------------ - --------- ----------- - Date _- SAN JOAQ N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M