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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� Permit No. _--"---------019 ;. (Complete in Triplicate) , 4 --C-91 ------------------ -- ---------------------------- ------- -"" � ` Date Issued �---�.------ -------------- This Permit Expires 1 Year From Date Issue ------------------------""--______ _--__.-_ i o construct and the r Application is hereby made to the San Joaquin Local Health District or a permit t and existing RulesandRe work konsrein described. This application is made in compliance with County ��. k ,. .wr.A" 1.174 . a eV CENSUS/TRACT -------------------------- _f . ADDRESS/LOCATI N - 7� d Phone --------------------•--------------- Owner's Name ._ -- -- Address --- ------ ------- ------ --- ---- ---------------- -- ----------- Y -------------- --------------------------- License # ------- ----------------- Phone ------------------------------ Contractor's Name ------------------------------------ - - - - Installation will serve: Residence tK Apartment House f-I Commercial ❑Trailer Court i❑ Motel ❑Other ---------------------------------------- -- 10- Number of living units------ ---- Number of bedrooms -�------Garbage Grinder -- - ---- Lot Size - . -------------------- l Private Water Supply: Public System and name ---------------------------------- ----------------------------------------- Character of soil to a depth of 3 feet: Sand Silt❑ Clay E] Peat F] Sandy Loam ❑ Clay Loam.0 Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ---------------------------- y .be placed on reverse side.] buildings, etc. rpust_ (Plot plan, showing size of lot, location of system in relation to wells, No 'se tic tank or seepage pit permitted if public sewer is available within 200 feefi,] NEW INSTALLATION ( P SEPTIC TANK Liquid Depth /�� ------------ N PACKAGE TREATMENT { ] Size__�-?rte-.�-`�---- ------"- � - q p � Capacity 1�Cd ' YP e -------------------- Material---d .�° C'N Compartments --- f-- Distance to nea st: Well .....67 0-----------------------Foundation __f -------------- Prop. Line --------- -=-------- LEACHING LINE No. of Lines __-� ---------------- Length of each line--__._ �!_____------------ Total Lengt�f-.V-16--------- 1 '.x p' Box "__ _____ Type Filter MaterialDepth Filter Material __ -_ ___ ._____._ _Z-,.--,------ Distance to nearest: Well --�------ Foundation ---je�--------------- Property Line -------- i SEEPAGE PIT [ ] Depth Diameter ---------------- Number --_____ Rock Filled Yes ❑ No .0 ------------------- i Water Table Depth ------------ ------Rock Size -------------------------------- c a I Distance to nearest: Well --------------------------------------._Foundation ---------------:---- Prop. Line -------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------- Date ----------------------------------1 Septic Tank (Specify Requirements) -------.--------------------------------------=----------------- ------------------------------------ i Disposal Field (Specify Requirements) -------------------------- ---------------------"-----""-- - ---- ---------------------- -------- -------- --- ------------------------------------------- - I (Draw exist ing and required addition on reverse si e l 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: f "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 becWiect to Wo kman's Compensation laws of California." t Signed - --------------------. Owner - - ---------------------- Title ------- ----------"----------------------------------------------------- (If other than owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ' - --- -------- ----------------------------------- DATE _.1 //----�----- �----- - --- -------DATE --- -------•----------------------------- BUILDING PERMIT ISSUED ------------------------- - - ---------------- ADDITIONAL COM --------------- -------- ----------------------------------- - ------------------ ---------- --------------- ---------------- ------------------------------------------------- ---------- -------------------------------------------------------------------"--------------- ----------------------------------------------- -------------- -------------------------------------------- ---------------------------------- F � --- --------------- ---------- Date ------ -----------*_ Final Inspection by:;- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M