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f +� 4 FOR OFFICE,USE: APPLICATION FOR SANITATION PERMIT ------------ ------------------------------------------- M 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 permit to construct and install the work herein described. This application is made'in compliance with County Ordinance No. 549 and existing Rules and Regulations: / ` � .,1--:c CENSUS TRACT s-q'--- ----------- JOB ADDRESS/LOCATI -_.<. 54--- 'W- --------- - Owner's Name ------ --- `- ----- f one ------------------------. Address 1 -G_ - _ 'tY - Contractor's Name a _____�__. icense # Phone Installation will serve: Residen e ❑Apartmen use❑] Commercial ❑Trailer Court ❑ Motel ❑Other -- -______-- -- ' ------ Number of living units:___________ Number of bedrooms ____________Garbage Grinder ------------ Lot Size --------------------- ------------------_- ck Water Supply: Public System and name ----------------------------------------------------------------------------------------------------------------Private Character of soil to a depth_of 3 feet•- Sand_'Q_Si.IL©_CI a.y-Q Peat-[I Sandy Loam ❑ Clay Loam :❑ t Hardpan Adobe ❑ Fill Material ------------ If yes, type ---------------------------- JPlot 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,) ( + F i PACKAGE TREATMENT�I? SEPTIC TANK j Size-- ----- -- ----X----'�----------- Liquid Depth -------:------------ •.----- Capacity', ��- TY.pe�. _-. --`--- - Material Compartments Distance to nearest: -Well ------------__�-;?�------------------ Foundation _Z_G------------- Prop. Line LEACHING LINE [ No. of Lines ________/_____________ Length of each line':_,_1___4470------------ Total Length 'D' Box ----- Type Filter Material ------S---fZ_--_Depth Filter Material ----/-�-----r_______________________ Distance to nearest: Well ------t�---__----- Foundation .______lo----------- Property Line ------- SEEPAGE PIT E Depth ---r�'_ �__r--- Diameter ____- - - Number __-___\__/__--_-/------ Rock Filled YesA No i❑ t ,` Water Table Depth J V Size`;_' �,)---.-�------ ---- � r Distance to nearest: Well ______________t b �---_-------__--Foundation,_----r` 0___------ Prop. line ________J.._...__..__ E , REPAIR/ADDITION(Prev. Sanitation Permit# --------.----------------------------------- Date -------------`-....................... Septic Tank (Specify Requirements) ---------------- ------------------------------------- ----------------------------z.----------- `------------- Disposal Field (Specify Requirements) ______--____ t ,-- ------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- t ------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- (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 become subject to W n s mpensation laws of California. Signed ----------------------------- 7----------- ------- -- Owner r - - ^�'� ----- Title �tl (If other than ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------- DATE 7-- --- ------ BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------- ----------------DATE --------------- -------- -----------, ADDITIONALCOMMENTS --------------------------------------------------------------__----------------------------------------------------------------- -------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- ------------------- -- ----------------------------------------------------------------------------------------------------------------------------- .� fG7` - ---------------------------------- Final Inspection by: __ --------------------- -------------------------------.Date/Z� 71------------------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -