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k � FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------- --------------------- Permit No. {Complete in Triplicate] _._________________________________----------------- This Permit Expires 1 Year From Date Issued Date Issued - 7 -- 9 Application is hereby made to the San Joaquin Local Health District for a 'permit to construct and install the work herein i described. This applica_ t�nj ad in pia County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION f cz � ►- K�'L1Cz CENSUS TRACT Name --n---- -----------FRF-o---FPPF : ©P u---------------•----------------------------- ----------------------- Owner's -Phone ------- ------ Address k' �1� Cityia —elf '21-------------------------------•---•---- 2r --off------••--•--. - 4 Contractor's Name --------------------------------1 .Q _ 4. '------------------ ---License # ---------------—-------- Phone -------- ---- `" ........... Installation will serve: Residence partment House,❑ Commercial:❑Trailer Court '❑ Motel ❑Other __ t ori --____________._.. Number of living units:---___ __-_ Number of bedrooms —'_____Garbage Grinder Lot Size _A;rT ��__________________- k � - 1 Water Supply: Public System and'name -------------------------------------------------------------------------------------------------------------Private E!I— f Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe [TFill 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.) Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] u PACKAGE TREATMENT [ SEPTIC TANK fl— Size____________10 _ ------------ Liquid Depth _______�t__&------------- Capacity _� i�_,:__ Type _ -- Material No. Compartments � Distance' to nearest: Well -r---------------------Foundation -----6.a------------ Prop. Line ---41---_______ LEACHING LINE [ j No. of Lines ---------A------------ Length of each line._..__TO---------------- Total Length -----&Id......... ._... `D' Box - ----- Type Filter Material &p--arc Depth Filter Material --------V ------------------........-- � .Distance to-nearest: Well- IN -_ -- Foundation"""' _` - —�" -� � ��" �•�'� -; Property Line - r SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ----- ---------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _________________________________ Septic Tank (Specify Requirements) ---------------------------------- ----------------------------------------------- ---------- ----------I------ Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------- - --------------------------- -----------------------------------°---------------- J--------------------------------------------------------------- --------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------k (Draw existing and required addition on reverse side) 1 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, t shall not employ any person in such manner k as to become su ' Workma ect to '',S.,C pensation laws of California." : i Signed ------ Owner -- - 1 BY ---- ------------- ---- ------------------------------------------------ Title ------ --------- (If other than owner) f FOR DEPARTMENT USE ONLY �f ---------------------------*1 I a-�a--�# D c?;paP�aI. APPLICATION ACCEPTED BY -------------------------------- ------------- - -- --- ---- --- -�- ----- •--------- BUILDING PERMIT ISSUED ---------------------------------------------------- -------------------------- ----------------- ---- --- -- T ------------------------ ADDITIONAL COMMENTS ------------ ----_ -__ _.._____________________ -------- ---- ---------------------------------------- ----- --------------------------------------------------------------------------------------------------- ----------------------------- ------- ' ------------------------- --------------------------- ------------------------------------------------------------------------ ------ i Final Inspection by: -------- ----------- �'��' at . --------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.