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FOS OFFICE USE:- { "APPLICATION FOR SANITATION PERMIT -� `" (9-1,,'4--71 ! -- 7I- 623 _ ------ -------- -- - ----- ----------------- ---- � - ,. Permit No: ------------- (Complete in TripEcate) ---------- -------- ---------------------------------- This Permit Expires i Year From Date Issued Date Issued J/_7/71 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 madeiin tom lian f a with County Ordin ante No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION `— ------- - --------------------- -- -----CENSUS T RACT -------------- ----------- -------------------- Owner's ---------- - - Owner's Name - - Phone z7 -71" CtY + --------------------•------ -- IAddress Contractor's Name _061cI y3----License Phone Installation will serve: Residerice Apartment House❑ Cornmerciaf ❑Trailer Court ❑ // ( ,,_ lNotel ❑ Other -----------------------I -------------------- II-------------- � . Number of living units:-___r-___ Number of bedroo �__LA_____G bags rinder _______---_ Lot Size J _fx��v--------- -�-*-'�C __Private --- Water Supply: Public System and name- C .. = ----------------------------------------- --- ❑ Character of soil to a depth of 3 feet Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan 0 Adobe Fill Material ------------ If yes,type ___________________________ 1 6 ; (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) II NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK" Size- �a'X__-----? _��__-_ Liquid Depth ---'i�-------__________ // ----- Capacity l,I&l2-------- Typeaxe S Material. '1 ---_______ No. Compartments ------ •...... Distance to nearest: Well __ _ - '_Foundation _440_`---------- Prop. Line 1i I LEACHING LINE No. of Lines ------ -------------- Length of each line-._-/P------------ ------ ------------------_-------- ' . Total Length � f/ 'D' Box ----- Type Filter Material s�,_� '��'_.Depth Filter Material ---------- W --------------------- Distance toinearest: Well -_ dJ �- ----- Foundation _-�L?-------------- Property Line -- 'c..... r !l ' SEEPAGE PIT Depth ____ _ ________ Diameter _32a-------- Number -- ---/---- Rock Filled Yes No I] _ Rock Size. ? .3 Water Table Depth----��----------------------------•------ - 4 =`---�-- ��------------ � Distance to inearest: Well -.-- LIN _--------"-�....Foundation ...... --"--- Prop. Line • ............... REPAIR/ADDITION(Prev. Sanitation,l Permit# -------------------------------- I-- Date --------------------------- -----) SepticTank (Specify Requirements) ------------------- ------------------------------------------------------------------------------------------------------------------------- DisposalField (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 "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 beco su ject to V�rkm Compen3atji laws of California.' 7 Signed ---------- ---- -------------------------- ------ Owner BY --------------- ------------------------------------6=�� ------ ----- ------ ----------- Title - --------------------------------------------------------"------------- (If other than owner) i FOR DEPARTMENT USE.,ONLY APPLICATION ACCEPTED BY _-- -- I DATE ---7-" - --------------•----------- BU[LD[NG PERMIT ISSUED ____ ___ DATE _.-___._______________ ------------------- ------------------------------" ,------------------------------- ------------------ ADDITIONAL COMMENTS _________________________________ �� i1l. ---------------- ---------------- -------- - ^- -------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------- ---- ��_7 ----------------- '1 ------------ --------- $ -- :--------- Final Inspection by: --------4----------- -- -e ---�----------- -----------------il - --- -.Date ------- -- --- IN JOAQUIN LOCAL HEALTH DISTRICT 11 G E. H. 9 ��l-'68 Rev. 5M ,