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r 1 FOR.OFFICE USE: APPLICATION FO SANITATION PERMIT '� Permit No. ------------------------------- - ------------------ (Complete in Triplicate) -- ------------- -----= p Date Issued ---------- --- - This Permit Expires i Year From Date Issued rict a permit and al the work hrein dApplication cribed Thishapplication iso made in compliance ecal Health with CounttytOrd Ordinance No. 5490 and existing tit the Rulesalnd Regulations- / f __CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION _.� o�--:----n'$------��'cG`------ ------- // Owner's Name -------.Phone -----------------•-------- -------- Owner's = ----- /- ,-/--------------------------------• �f_Ijw-------- 11�__dJ-f s�-�_`---------------- --. City � ------------- Address __ _- � � r �� Contractor's Name - � ��,_.License # -__�.�'7,�Phone _��-�-�--�� installation wit! serve: esidenc partment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other --------- -------------------------------- Number of living units:....r_----- Number of bedrooms __---__.Garbage Grinder ------------ lot Size ____ Water Supply: Public System and name _________________ ____---------- ------- -•-------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ , .Adobe=❑- Fill Material_-__7=_ If yes,type _--- - ---------------------- Hardpan-S .- - (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,) Il, ! .-•• V' PACKAGE TREATMENT [ ] SEPTIC TANK Size-------------- ------------------ Liquid Depth ------S ------ Capacity__il:Z.C- :.__ Type G` �Material____6 -- No. Compartments ___- --------------- Distance to nearest: Well ______ --- ------------ Foundation __-- --f-Q____._-__-- Prop. Line _-57-- f= - -• -- ------• ___C�-�? - � LEACHING LINE [ ] No. of Lines ___.-.3---_---------- Length of each lire--] _Q Total Length�__...�2_,,7Q•--------� - rr ' _z� ' aterial ___,/ --------- ----------- ----- :D' Box-L�--- Type Filter Material -------�-_ Depth Filter M-- f Distance to nearest: Well _. --__-____-- Foundation ----- __ ____________ Property Line ...... Depth Diameter ________________ Number Rock Filled Yes ❑ No SEEPAGE PIT [ ] p -------- ----- WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance ----------------------- ------Distance to nearest: Well --------------------- ---•--Foundation --------------- ---- Prop. Line _.____-.-_---_--._-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______.-____----------------.-----1 Septic Tank (Specify Requirements) --------------------------------- -----------------•----------------------•--- Disposal Field {Specify Requirements) ------------ ------------------------------------------------------------------ ----------------- --------------------------------------------------------------------------------------------------------- ----------- - -- -- - ---------- - ..---------------_--------------------------- ------- -. _ : ----_-------- ----------------------------.--------- ------- r T ' " - (Draw existing and required addition on reverse-side) 1 hereby certify that 1 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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: i "I certify that in the erformance of the work for which this permit is issued, I shall not emplay any person in such manner as to become su ork an C9 pens 'on laws of California." - Signed ----------- --- ---- ----- - - - ------ Owner • BYTitle --- - ------------------------------ (If other than own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 'BY ----- -----------+k-`-------- ---- -------- - - DATE ....... �p 73 BUILDING.PERMIT ISSUED----------7-------------------- -------- DATE -------------------------------- ADDITIONAL COMMENTS __�" '---------------- ----------- ---------------------------------I----------- r --------------------------------------------- - -------------`., >-------------------------- - ---------------------------------------------------- ___ _____________________________________________________________________ _____________________________h___.________..---_.._____ _..._________�_________-_____.___ _ _� ______ _______________ Final Inspection b -------------------------------------------------------------•-------- Date __.. � SAN JOAQUIN LOCAL. HEALTH DI TRICT E. H. 9 1-'68 Rev. 5M