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� pRr,OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- -------------------------- --- Permit No: ._7_1_-_iTP .7 (Complete in Triplicate) ---------=----------------------------------------------- -------------- -- -------- This Permit Expires 1 Year From Date Issued Date Issued --- _7>/ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is mad ,in ogpl�iance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . �� -- - = '" --- """------------CENSUS TRACT -------------------------- --- :- - hone Naroe ------ - Address =- =---- City -- � # �-- ---- ------------------------ x►,e� 44 License # ------------------------ Phone .----------------------------- f Contractor's Name. ---- - ----------•---------------------- - -----------•-=------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other --- ------_._.. Number of living units------------- Number of bedrooms __--_-----Garbage 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 El 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,) PACKAGE TREATMENT [ ] SEPTIC TANK:K Size-__- --- Liquid Depth .--- � o Capacity/.__6__C)"_6_ Typ ._- _ Material__ o. Compartments _-_-.______--:_-_- 0 Capacity/._16__C)__6__ Distance to nearest: Well _ __. _ ______________Foundation —_lP----------- Prop. Line -_______-"__ �4 LEACHING LINE No. of Lines ___-_- Length of each line___ ___ Total Length [ ] ! - ��27 D' Box ------------ Type Filter Material . Depth Filter�Vlaterial ! .*r,.r -. — �,.� - -- Foundation -�---�Proper .. Line.,_.__�� =------ - Distance to nearest: Wefl _ - - ---------- tY; SEEPAGE PIT [ ] Depth _____ ___________ Diameter ---------------- Number -------- ------------------- Rock Filled Yes ❑ No is -4 Water Table Depth ----------------------------- "" ' -----Rock Size -------------------------------- # ' Distance to,nearest. Well ----------------------------------------Foundation ---------------.---- Prop. Line ---------------------- . REPAIR/ADDITION(Prev.,Sanitation Permit# -------------------------------------------- Date ----------------.--.--------------) Septic Tank (Specify;:Requirements) ---------------------------------------------------------------------------------------------:------------- ------ R f- > ____________ ______________ _Disposal Field (Specify Requirements) _______________ ____________.______-___ - _rf ---!->-- - ------f-- ---- -- (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 t96 p performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subiect to Workman's.Compensation laws of California." Signed ------------ ---------- Owner ►,� BY ----- Title . ( h - ------------------ J , her t��. owner) x FOR DE�PA TMENT USE ONLY APPLICATION ACCEPTED'-BY ---� -4------------ -- -- DATE _ -- -------- ------------------- - ------------------ - --- --- BUILDING PERMIT ISSUED:----------•`=---------- '�- -=- - -- DATE -------'---------------- -------------- ADDITIONAL COMMENTS . , -w____ -__- == - ' ---- ---------------------------------------------- - _ ------- ---_------------------------------------------------------------------------------------ ------•-------- ---- --- - t ----+ ----- ----------- - -------- - - -- --- - Final Inspection by= ----------------------------------------- ----- -------------- Date ---- -- Z'.r SAN JOAQUIjV rLOC�4L .H LTH DISTRICT -E. H. 9 1-'68 Rev. 5M tw ; N `