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FOR 6FFICE USE: APPLICATION POIR SANITATION PERMIT (Complete in Triplicate) Permit No. _- ----i -.. ' --- l----- This Permit Expires t Year From Date Issued Date Issued ---------- ------ 3_r. � tea' " 2 t -q s � 7 Application is the San Joaquin local Health District for a permit to construct and install t e work herein described. This application is made in compliance with County Ordinance No. 5,49 and existing Rules and Regulations: / JOB ADDRESS/LOCA -.-._ r _- --c9 ' s [---------CENSUS TRACT -------------------------- Owner's Name air" -- ��z , ----- - --- ---Phone ----------------------- -- --- Owner's Name _ _ Address Contractors Name --- f ------ ---------.License # ------------------------ Phone ---------------------------- Installation will serve: Residence partment House❑ Commercial :❑Trailer Court ❑ i Motel F-1 Other ---------------- E / _ _, Number of living units:--.- -1.._ Number, of bedrooms ----/-----Garbage Grinder .----------- Lot Size --- -' ------_--------------------------- Water Supply: Public System and name ---------------- ---•------------------------------------------------------------------------ ---------------Private El I Character of soil to a depth)of 3 feet: - Sand'ET Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ----- If yes, type ------------------_-----.._ f (Plot plan, showing size o lot, location of system in relation to wells: buildings, etc. must be placed on reverse side.) i i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT [ ail SEPTIC TANK f4— size------------------------------------------------ Liquid Depth ---:751�-_.------- Capacity QC9t? _ Typej4C_4a�IC Material--- Compartments - -................r .1. _ > 1 � ! s Distance to nearest: Well ?1u_ _____'_______________Foundation ---------------------- Prop. Line ----cS"-____---_--_ 9 LEACHING LINE [v a. of Lines --------/-------------- Length of each line----/-0o------------- Total Length ......AAp...`-_-_-_. --- t D'I Box _____ Type Filter Material V4411- Filter Material --� _ t Distance to nearest: Well PROW_ _ --------- Foundation ------------------------ Property Line. - -._-.--...-.-_.'3 SEEPAGE PIT Depth - Diameter ---------------- Number --___- ------------------- Rock Filled Yes ❑ No i❑ Walter Table Depth ---------------------------------------=-----"Rock Size----_----------------------_•---- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line -------------------_._ REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------- Septic --_---------------_-- _-..Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------- -------- -----------------. ,l Disposal Field (Specify IIf Requirements) --------------------------------------------------------------------------------------------------------------------- -------------- N' ------------------------ --------------------------------------- ---=I--------------------------- - ------------------------------------------------------------------------------------------------------------------------------ (Draw existing and required addition on reverse side) I hereby certify that I hav l 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 Iicen- sed agents signature certifies the following: "1 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 bec a su ct to Workman's Co pensation laws of California." r Signed - ,. - ------------------------------ Owner Title i BY ;� - ---------------------- -. -.------------------- ------- -- -------------------- a (If other than owner) _ FOR DEPARTMENT USE ONLY M „ - APPLICATION ACCEPTED BY --- -------------------------------------- DATE --- ------------ BUILDING PERMIT ISSUED 4 ----- - - -=- -------.DATE ----- -------•----------------------------- ADDITIONAL COMMENTS �I -.--- --------------- --- ----------------------- -) ------------------------------- ---- ------------------------- ' _ , -------- ------ - ------------------------------------------------------------------------------------------------------------------------------ I ----- ------ Final Inspection by: --- --- T_ ---------------------•- `- _-------------------------------------------------------------------------------- -------------- _. �1�� -------------- 3 JOAQUIN LOCAL ,HEALTH DISTRICT j' E. H. 9 �. 1-'68 Rev. 5M ' Y