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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �U ------------------------------ ------------------------- Permit No. -__------- (Complete in Tiriplicatell '�0---------=---------------------------------------- -- This Permit Expires 1 Year From Date Issued Date Issued 1-F Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This�pp��ion is made in compliance with CountyfJrnce No. 549 and existing Rules and Regulations: -- --- `X205 _rrc I _i /2 � ---ai�t 7.._CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION Owner's Name _ AAR 0-------- ---11L-----1- ------Phone ------------------------------------ ---------------------------------------- --- Address _t�- Qf Glx r ----------------------- City l Contractor's Name License #� PhonecS:"fJ Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other ------- ----------------- Number of living units_____________ Number of bedrooms ------------Garba_ge Grinder .----------- Lot Size _ Ae--c------------ Water Supply: Public System and name ----------------------- -----------------------------------------------------------Private 5' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ,❑ Clay Loam ❑ Hardpan ❑ Adobe'❑ 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 permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT SEPTIC TANK Size _ ?r M____ _Y1 - L_P-- -------- Liquid Depth - ---------- _e rtmen#s ------ --- ------- Capacity Type � [ ateria � . f l Distance to nearest: Well --------------------Foundation Prop. Line -`S______._.,------ r LEACHING LINE [ j No. of Lines ------j;Li------------- Length of each line---- ---------- -- Total Length l -©----•.-------- g 'D' Box ------------ Type Filter Material PaM;'------Depth Filter Material f-9-__---------------------. _1------ / --- Property Line ---------------- Distance to nearest: Well -------6--C?-1----- Foundation _-_-L- -------- p tY SEEPAGE PIT Depth - Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth -----..Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _---_____-____....-.-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------------------ ----- ----------------- ------------------ Disposal Field (Specify Requirements) ----------------------- ----------------------------------------- -------- ------------------------------------------- ------------------------------------------------------ - ---------------- - - (Draw existing and required 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 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 become subject to Workma 's Compensation laws of California." Signed __ ------- -------- Owner �— Com' ---- ---------- ---------------------------- �- ------------------------ Title (If other t an owner} //FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- DATE ----'Yf ------------------ BUILDINGPERMIT ISSUED ------------------------ ------------------------------------------ --------------------------------------DATE -------------------------- ---------------- ADDITIONALCOMMENTS ------------------------- -------------------------------------------------------------------------------------------------------------------------- ------ ------------------------------------ ---- ------------------I------- P Y- ---------- gate 7v --------------------------------------------------------- Final Inspection b .+�=�-�----- ----------------------------- ------------ - ' ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M