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,T. FOR OFFICE USE. F:--, APPLICATION FOR SANITATION PERMIT ------------------ ------ (Complete in Triplicate) Permit No. 7-3-x_10 r i. ' -----`--- ---------------------------------------------- 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 Ordinance No. 549-and existing Rules and Regulations: r - - JOB ADDRESS/LOC TION f,-4 - -- --.I ,. _ CT ----- �----- CENSUS-TRA Owner's Name ------------- Addrress _ f_ _ Phone _. 5'---�� -- Cne - '- -- --- ------------------------------------ city _ Contractor's Name-_____ ________ _ _ 70 -------- --------•-- - ------------------------------------------------- - ❑ icense ------------ ---- Phone Installation will serve: Residence j�artment HouseC] Commercial :❑Trailer Court Motel ❑Other Number of living units: '- Number of bedrooms ---!Garbage Grinder Aid Lot Size __ --g-�% R. ------------- -- G Water Suppfy:-Public System and name _"_` --- ---` `_--" f i y Peat Sand Loam Clay Lc Prrvate�]/ Character of soil to a depth of 3 feet: Sand'0 Silt❑ Ch Sandy ❑ y a m[] 'Hard m�- �.► pan Adobe ❑.. Fill Material ------------ If yes, type --------- -- ,(Plotplan, showingOize 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,J AMENT SEPTIC TANKSize PACKAET7 -----^-�-�-�=------- ------ Liquid Depth ---------- -- V CCapacity --------------------- Type -------------------- Material------------- - No. Compartments ------------- Distance to nearest: Well ------------------------------------Foundation-------------- --- prop. Line -----_----.------------ LEACHING LINE [ ] No. of Lines ------------=----- ----- Length of each line_ _'_ -F--=`_-----:a Total Length -------------- • ---------- 4 ` D' Box ._----._--.. Type Filter Material ____________________Depth Filter Material Distance to nearest: Well _______________________ Foundationroperty Line _ - _ _ __ ------------------------ P ------ ------- EEPAGE PITDepth --------------------_ Diameter _ Number ------------------ ______ Rock Filled Yes .❑ No i❑ L l Water Table Depth --------- --------------------------------------Rock Size Distance to nearest: Well ----------------------------------- ----- -------------------- Prop. Line -------•-------- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________ --------- ----- bate --------•----------•--------------1 Septic Tank (Specify Requirements) -________________ Ad ----------------14-------------------------------------- Disposal Fiel (Specify Re uirem nts) Q . .�. r f� ------------------------- -------------------- (Draw existing and required addition an 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 bec subject to rkma�,,nsc' tion laws of California." Signed - Owner ---------------------- By ---------------- --- --------------------- Title - - -------------------------- (If other than owner) ------------------------------------------------ FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY .- - BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS _____ _____________________ _ --- ---DATE --------- -------- ------- e ---------------•--------- ----- .. ----------------------------------- --------------------- ------------------------------------------------------------------------ ------------ Final Inspection by: -_ - --•.-_ _ Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M