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. ._ f FOR OFFICE USE: -'° APPLICATIONFOR SANITATION PERMIT y Permit No. __-7//------ --------- -------- -------------------------------- _ (Complete in Triplicate) Date Issued //-7 This Permit Expires I 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: A -------- CT JOB ADDRESS/LOCATION ---- �S__JQC Phone 93 5-- -��-9-7-- i Owner's Name 2 C {y --------------------------------------------------- 7 S------ ------- GAddress Phone License --�---Contractor's Name Installation will serve: Residence ❑ Apartment Hou e Commercial []Trailer Court i❑ Motel ❑Other ........... Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ------------------.-------------------------- Water .__ _.____ _Water Supply: Public System and name ---------------- ----------------"------------------------ -----------•_Private r j_.,Character of soil to a depth'of 3.feet:- .Scind�Q _Silt_0 Clay ❑ Peat❑ _ Sandy Loamy❑� Clay Loam Hardpan ❑ Adobe ,E] Fill Material ------------ If yes,type ---------------------------- (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 permit ed if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'f ] i�i`e--- _ q 1� �I - ---------- Liquid Depth .-- -- ----- Capacity Type � Material_Oi4No. Compartments J ------------••-• .. el Distance to nearest: Well ------ --------------------- ---------------------Foundation ----1___�------------ Prop. Line ---a--�.. O LEACHING LINE [ ] No. of Lines ________________________ Length of each line---------------------------- Total Length ,_-________.__.____..______- p 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------•------------------. Distance to nearest: Well _______________________ Foundation - Property Line ______-______.___... -- N SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------------------ Rock Filled Yes ❑ No '❑ . WaterTable Depth ------------------------------------------------Rock Size ------------------------------- i Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ..-__---.......------- - REPAIR/ADDITION(Prev. Sanitation Permit# _-----------------;----- ------------------- Date ____--____------------------------) Septic Tank (Specify Requirements) -------------------------------------------- ---------- ------------ ----------"--- - ------------------- ----------------------------- " Disposal Field (Specify Requirements) ------- --------------- -------• ----- ----------------------------------------------------------------------------•--------------- �_ _.C� - ---- ----- ---- ------------ P__ _1 0_ - --------------------------------- ------------------------------------------- ---------- - -- ---------------=-------- ----------- {Draw existing and re-quired 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 followings "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - -.__ Owner ' Title --------------------------- -------------------------------------------- (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------- --- ATE A270-21------------------- D-- --- ---------- E PERMIT ISSUED ----- -------------------------------- ------- ------------- --------- - ---- -- ------ -------DATE --------------------------- ADDITIONAL COMMENTS --------------------------- ----------------------------------------------------- ---------------------------------------------- - - ---------- --- ?;/------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -- ------------- Inspection b --Date ---e _k3 2-___."."._-"-""-------- SAN JOAQUIN LOCAL HEALTH DIST T E. H. 9 1-'68 Rev, 5Mx =