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FOR OFFICE USE: . I / 1 APPLICATION FOR SANITATION PERMIT ------------------------------ f7 � V_ I y ' !". Permit Na. 76_-1�- (Complete in Triplicate) r/ ------------------------------------------ -------------- __�=�,Z'-�� --------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �� - ------�' _r__---- - - CENSUS TRACT ------------- ------------ - Owner's Name __:_- - --Phone Address / ------------------------------------------ ------------ - --- -- --- ---- City Contractor's Name __ + - ?'_ __� __._______.License # Phone Installation will will serve: Residence ❑ Apartment House-E] Commercial frailer Court ;0 Motel ❑Other ------ - ----------------------------- Number of living units:_______ ____ Number of bedrooms ____________Garbage Grinder ------------ Lot Size ' _____________ Wafter Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private ! ' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [] IHardpan ❑ AdobeFill 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.) k NEW INSTALLATION: ^� (No septic tank or seepage pit permitted ifpublic sewer isavailable within 200 feet,) � PACKAGE TREATMENT { ] SEPTIC TANKjj< Size_V4Z K5_,1 C? -------------- Liquij Depth""""' ` -----.----•_-- Capacityl�dd-------- Type eA aMaterial_- ___ No. Compartments ----------------- Distance .__- `"--Distance to nearest. Wel! ___ __________________________Foundation __eZ_Z-- Prop. Line LEACHING LINE ' No. of Lines -T-/z--_----_------- Length of each Ii ne__�r-�__________________ Total length ---9 - 'D' Box ------_, Type Filter Material!._ __ Depth Filter Material ____ ________ ___ _________________ 1 Distance to newest: Well _______ Foundation _+ .----__--_.__ Property Line -, -- --- A i. / SEEPAGE PIT Depth __ ----_____ Diameter _-_--_---- Number ------!_----------------- Rock Filled Yes ' 'No i❑ ! Water Table Depth --- -- --------------------------------Rock Size -- _�- ------------- R 1 a � f Distance to nearest: Well _.X�_________________________Foundation -_ ---------- Prop. Line ---------------------- REPAIR/ADDITION _ --_______REPAIR/ADDITION(Prev, Sanitation Permit# -------•------------------------------------ Date __-_------------------------------j Septic Tank (Specify Requirements) ----A----------=----e------- -- - f yDisposal Field (Specify Requirements) ------------ -- '-'�--- ---------------------------------- --------------- ------------ _ ------------------ _ _ (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, 1 shall not employ any person in such manner as to bec su ject to kW rkma� Compensatll! tibws of California." #1.4 Signed ------------- ------- Owner -� BY -- ------ -- F� $� <" � '+' -"�--- Title ---------------------------- (if other than owne{{r) I FOR 'DEPARTMENT USE ONLY �a APPLICATION ACCEPTED BY .--'.1_-__-- tai--- - DATE __.-__.1."- - "-- "------------------- BUILDING PERMIT ISSUED --------'!______ ------- DATE - -- --------------- iADDITIONAL COMMENTS -- ---- I - ------------------- ------------------------------------------------------------------------------------------- ----------- - ---------------------------------------------------------------------------- - - ------------------------------------- - -------------------------------------------- ---- - ------------------------------ Final Inspection by. __ Date --_-_ '--t_ ` ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M