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FOR OFFICE USE: � � -- `APPLICATION FOR SANITATION PERMIT 7 /0 7 � ' - _ A A . . � -Permit No. - -_=--- - .. �. {Complete in Triplicate) ' = ---------------- --------------------` I I Date issued ._�I--- -- --- � ------ -- Application -------------------- - ;This'Permit Expires 1 Year From Date Issued F I pp cation is hereby made to the San Joaquin Local Health District for a permit to construct and instal! the work herein described. This application is made in compliance with County Ordinance N'. 549 and existing Rules and Regulations: i # JOB ADDRESS/LOCATION CENSUS TRACT ; ` s Owner's Name ___ = Phone ��f��ir'.-------- Address -------- E' ip ' /AL1.----- r----------------------------- City ' E Q�'- se --- Phone Contractor's Name � _; _ ------'- l Installation will serve: Residence Apartment House Commercia` -]Trailer Court ,❑ I Motel ❑ Other -`------------------------------- I. Number of living units:--_ _ Number of bedrooms _3_--____Garbage Grind€€er a----- Lot Si a 1Q.3F---.ylva--------------------- Water Supply: Public System and name --------------------------------------------------------------I�--------------------------------------------------Private ❑ f Character of soil to a depth of 3 feet: Sand silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam :❑ f i ❑Hardpan Adobe Fill Materia! --- -------- If yes,type ---------------------------- O p ❑ (Plot plan, showing size of lot, location of system in relation to wells: buildings, etc. must be placed on reverse side,) NEW INSTALLATION: 1No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 11.PACKAGE TREATMENT SEPTIC TANK Size-- �! ------------------ - Liquid Depth - - -------.- --.----- Capacity, _ 'Typej ` -- Materialef� No. Compartments _________________ Distance to nearest: Well -7� --------------------------Foundation ----ld r__.___-- Prop. Line .- --._. :---___--- { i _.- LEACHING LINE � '�No of Lines -T1=__',_�._____— -- Length of each line a(__g_ ------ Total Length ______ _____ ________ ��,. I �I i� D' Box,(/ ---.__ Type Filter Materials ;9 Get------Depth Filter Material _1Q__________________________________ Distance to nearest: Well ------ -----_ FoundationJ-a_/----------------- Property Line __ -------------7---- SEEPAGE PIT Depth Didmeter _ __ p Number __________________________ Rock Filled Yes E] No [ ] Water'Table Depth --------------------------------------------# • ' x _. -:-w_-- ---- --------- r E ----Rock Size -------------' . k t i Distance to nearest: Well - -- ---------------Foundation -------------------- Prop. Line -------=._..:-•-_--_-- I .. . 1 - REPAIR./ADDITION(Prev'Sonitation Permit# -------- ------------------ ------ Date ------------ ---...------;-------) 44 . , ISeptic Tank (Specify Requirements) -------------- --------- -—--------------------------------- -----------------------------------------------_-------------------------•- DisposalField (Specify Requirements) ------------------------------------------------------------------------------ ------------------------------------------------------ t -------------------------------------------------------------------- ----------------------------------------------- --------------------------------- ----------------------------- ---------------------------------- ----------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work ill 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: Zc "I certify that/subje erformance of the work for which this permit is issued, I shall not employ any person in such manner as to becomeo k an's mpensati.on laws of California." Signed ---------- --- - - --- - ----------------------------------------------- Owner BY - ------------ Title -- ---------------------------------------------------------------- -- ---------------------- ---------------------------------- t of r than owner) FOR D �WTMENT USE ONLY APPLICATION ACCEPTED BY --- ------ 1- ee `- ---------------------- DATE ------------------7-- --7--/------------------- ------------ BUILDING PERMIT,,.ISSUED ----------------------- --- -------- ------ - ----- ` DATE - ---------- ----------- - - - ADDITIONALCOMMENTS ------- --- ----- --------------I------ ---------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- --------M-------------------- ---------------------------------------- --------------- ------`M------1---- -----------------------------------------------------=--------•- ----------------------------------------------- - - - - --- - -- - - f/—/ Final Inspection by; --------- - -- -- ---�----------_---�"---------------- --- --------- ----_-;k------------------- --.Date -- ----- 9�-?�--- SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M.