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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No..---7-------------- This Permit expires 1 Year From Date Issued Hate Issued -� 3�=_73•. Application is hereby made to the San Joaquin Local Health District for a per it to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J013 AQQRESS/LOCATION . _ -�___ --� d- ------- ----- ---- ---- CENSUS TRACT Ifni Owner's Name A " I-1-h. -_U _ Q-------------------71---------------- -------- -------Phone LO U1t City / License #' 1-_ __�n_-_ _ Phone _ _"G�2`�' Contractor's Name ___-___ ___ _._. fq_ - � Installation will serve: Residence t Apartment House]] Commercial :❑Trailer Court ;❑ Motel ❑ Other ----------------------------------------•- Number of living units:.--- ------- Number of bedrooms --- Grinder ------------ lot Size - -------_---- Water Supply: Public System and name -------------------------------------------------------------------------------- ------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'• Silt❑ Clay .❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ____________________________ k (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) v NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r , PACKAGE TREATMENT [ ] SEPTIC TANK.j ] Size----c7 _f 6 ________ Liquid Depth . - __--------- Capacity -f�0 ---.--- Type(V°-`Material- � No. Compartments ___�................ i Distance to nearest: Well ----------5-0--/ -_1-a___________ Prop. Line __ ............... r 1 S�� LEACHING LINE [ ] Na. of Lines ------:Z Length of each fine_ 7_0-____________ Total Length ,_ __________.___....._....__ D' Box 1----------- Type Filter Material ----Depth Filter Material ----/F---------------------------------- -Distancto nearest: Well ------.- Foundation ___________________---- Property Line _4` �I ( O k -SEEPAGE PIT—[-] Depth -.�---_------------- Diameter--------,-,-:-_,_ Number ---_---------------------------- Rock Filled Yes ❑ No .0, Water Table Depth ------------------------------------------------Rock Size ------------------------..--•--- s Distance to nearest: Well _________________________________________Foundation --------------- ---- Prop. Line .....__...__________-- I REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------------.-rt----------------------------------------------------------------•------------•----•-----------•-------------------------••- Disposal Field (Specify Requirements) ----------------•--•-------------- -- -----------------------------------------------------------`-------- ------I----------- [` ------------------------------------------------------------------ - i --------------- ---- ------------ i I � (Draw existing and required addition on reverse side)_ I .hereby certify that 1 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 shot 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 Work an's Compensation laws of California." Signed - ---------------------- Owner B. -"-- -------------------------------------• Title ------------------------------------------------------- (If other than owner) FOR . PARTMENT USE ONLY APPLICATION ACCEPTED BY _--- --- -----------. DATE ---/ ---`/-` -� ------------- BUILDING PERMIT ISSUED --------------------------------------------- --- --------------DATE ---------------------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------- ----------------------------------------------------------------------------------- --------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------- - --------------------------------------------------------------------------- ----------- ��} =l�L G /r✓ _ Date ._ Final Inspection by: ------- ' ------- SAN JOAQUIN LOCAL HEALTH DISTRICT S r� E. H. 9 1-'68 Rev. 5M �'UO