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FOR OFFICE USE: i APPLICATION FOR SANITATION PERMIT -------------------- ------------------ ------------- Permit No. _-7-1i_._5_,? (Complete in Triplicate) ---------------------------------------------------------- Date Issued __.•-`____?`_�_7 Y _ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Jo quin Local Health District for a per to construct and install the work herein described. This application is made in corr,pliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _� �� '.c' i ` CENSUS TRACT .. - Owner's Name --(� ____ --------------- - ---- Phone - Address ---- --- ei ' Contractor's Name ---- -" ------ ------- - ense # Phone � s Installation will serve: Residence Apartment House❑-Commercial :❑Trailer Court ',❑ Motel ❑ Other - ------------ -------------------- Number of living units:-___ ------ Number of bedrooms ___ ___Garbo e Gririder __-__ --------•-- _._-_ Lot Size ___ -- ------------- -------- 9 _ 1 Water Supply: Public System and name -----------------------------------------------------------L6-------------------- ----------------- - ----------Private I Character of soil to a'-depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat E] Sandy Loam ❑ Clay Loam .E] HardpanX 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.) y NEW INSTALLATION: (No septic tank or seepage ,In permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I -SEPTIC TANK i[ J = Size------------------------------------------- ---- Liquid Depth ------------------------- I ` Capacity - ------------------ Type -------------------- Material---------------------- No. Compartments ------------- ........ O Distance �to nearest: Weil ---------- ;_---------------------Foundation ---------------------- Prop. Line _____-..______...___-- � LEACHING LINE [ ] No. of Lines ------ ----------------- Length of each line--------------.------------ Total Length ---------------------------- i 'D' Box -------- -- Type Filter Material—------- ------------Depth Filter Material -------- ' } - Distance to nearest: Well ___________________'___- Foundation ____---_.______-------- Property Line _____________-__--.--_ I _ _ . ,.-...,p\ SEEPAGE PIT R [;� r= Depth ____________________ Diameter ____________-__ Number ______---___.__.------__---- Rock Filled Yes ❑ No i❑ %Ile Water Table Depth -_ E Rock Size ---------------------------•---- Distance to nearest: Well -------------- --- -----Foundation -------------------- Prop. Line --------- ------------ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- -- Date --------------••------------------1 Septic Tank (Specify Requirem'dnts) -----;-:-- -:----------------------- -------------------------------- -------- ---------------�...._ -- ------ ----- -- ----•---- Disposal Field,(S ecify Requiremen s) `___-�.,._•�.-�----- -----=---- -- - j : - ' ----- -------------------------------------------------------- --------------------------------------------------------- - -------------------------------------------------------------------- s (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 subie orkman's Compensation laws of California." 4... _.. __ _.__- _i_. _ __ - . ___A__ ' --- --- ---------------------- wneSigned - - -; ----B = - (If other than owners I FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY . - ----- ----- ---------------------------------------------------------------- DATE +�"�`-r- --------------------- BUILDING PERMIT ISSUED -------------------------- --------------------- -------------- --- ----------DATE ------------- ------ ADDITIONALCOMMENTS ---------------- -------------------------- ------------------------------------------------ ------------------------------------ ------- -------------------------------------------------------------------------------------------------------------- ------------------------------------------------- - -------------------- - ° = ---------------- ------- ------------------------ -- -- __ _ ----- `-Date`--Final Inspection by: - - -- -- - -- - -- - -- - - i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M