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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- -- ------------------------- --- y 2_10 Permit No. (Complete in Triplicate) _________________________________________________________IThis 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 compli with County Ordinance No. 549 and existing Rules and Regulatio 10 JOB ADDRESS/LOC N .__ 7 -__ ____ :_ -d- ' � ------!��----------CENSUS TRACT Owner's Name .- - ------ ---'7`v!`-------------- --- - ---- ------------------------------------------------------ -------------------Phone Address--30 00 _ _ __ _ _ !_ (_•_ r City Contractor's Name --- __ ---- __ _ _ � -_ __.e-_.--__-License ---- _ Phone - " �` Installation will serve: Residence ( (Apartmenl'House,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------ ------ /� f Number of living units:------/---- Number of bedrooms -----I-----Ga a Grinder ---_J,otSize --- ---------------/_______________ 1 Water Supply: Public System and name ________________________________ ___ -------- _------------------------------------._...Private❑ (� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E-] PeatE] Sandy Loam ❑ Clay Loam Hardpan E] Adobp6 Fill Material .----------- If yes,type __________________-___-__ V vim. (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 TANK,[ ] Size----------------'_------------------_------------ Liquid Depth ___________--.----_-_-_-. Capacity - Type -------------------- Materidl--------------------- No. Compartments ...................... Distance to nearest: Well _____________________---•-.._-__ Foundation ---------------------- Prop. Line ______________________ LEACHING LINE [ ] No. of Lines ------------------------ Length of each lirEe-------------- --------_____ Total Length ----------- ...... 'D' Box ------------ Type Filter Material ____________ y"bepth Filter Material ---------------------_---_ Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------_---- SEEPAGE _________________ __SEEPAGE PIT [ ] Depth -------------------- Diameter ______________ Number ---------------------------- Rock Filled Yes '❑ No 0 Water Table Depth -------------------------------------- ---------Rock Size ---------------------------•---- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______________________-_-____-_-_-_) � Septic Tank (Specify Requirements) ------------- ------- ------------- ----- Disposal Field ecif equirements) ________ ____ _ _ ._ �_______ -- ------------ ----------- ____ _____ ---- ._ _ _ __<_� (Draw existi g and requiredciddition 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 si ture certifies the following: "I certify th t in he performance the workoiaaws hick this permit is issued, I shall not employ any person in such manner as to ject to Wor Co pe of California." Signe --- ---------- E - ----- ----- " . -------- -- BY -------------------------------------- - Title ` -� ----------------------------------------- (If other than owner►. FOR DEPART NT SE, LY APPLICATION ACCEPTED BY ------- --------- ------ - ----------- DATE _-. � ---------- BUILDING PERMIT ISSUED __-________________________- -__.____________DATE ______-___.-_._-___ ADDITIONALCOMMENTS - -----------------------------------------------------------------------=---------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- ------------------------------------- ------- ----------- ----- - - --- ------- ----- Final Inspection b ________________Date F _l____ _ -_ --_____-_,_- SAN JOAQUI L ?AL E T DISTRICT E. H. 9 1-'68 Rev. 5M