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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ... Permit No. _ 36------- i (Complete in Triplicate) ---------------------------------------------• Date issued - ��.. -------------- This Permit Expires 1 Year From Date Issued f 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: ki 4..1�: -- JOB ADDRESS/LOCATION _his.��-----`------tJ`�--- 7� _ v- --------------- CENSUS TRACT ,q �� wSe�?ti. ��,--- �P �---------------- ---- ------------------ Owner'sPhone _ _t_35-. Address ---1►-c>�'�---- --54----- ----------------------------- Name 4.�A V-•�-�-�---- 4 - �-�-'-'�'�-'z�---- .f��a�-----�-- ----------. City -- Fcz.�.:i�c.��`.- -��-•� Contractor's Name --------------------•-- ------------ -------- ----------- ----------- - -----License # --------- -------------- Phone Installation will serve: Residence ❑Apartment House❑ Comm iaf ❑Trailer Court Motel X Other _ tk` !�_- 0-`--- Number of living units:---_11------- Number of bedrooms ---3------Garbag ,Grinder _--K:io--__ Lot-Size --" ____`______ Private Water Supply: Public System and name _________________________ -- a Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ peat❑ Sandy Loam . Clay Loam El x 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,) �� 1 i . i� ii _ PACKAGE TREATMENT I ] [q SEPTIC TANK Size-.11 fix -------------- Liquid Depth ------------------ is Capacity�i CLQ__ `,Type _r_*_ea s.----- Material--- � � -�_ No. Compartments ---------------••--•-- �_____--r ._ Distance to nearest: Well PP x=----Afa-'--------Foundation ---- Total Prop. Line I ttLtx__ 2r -----3______________ Length of each line._____: . `-- Total Length _ y I LEACHING LINE j ] No. of Lines 9 . 'D' Box __yP_S_._ Type Filter Material --------------------Depth Filter Material -------A--------------------------....... - Distance to nearest: Well __Appo1ii--- Foundation Property Line , 0(--__-- SEEPAGE PIT [ } Depth -------------------- Diameter ---------------- Number ------------ ------ Rock Filled Yes ❑ No C h Water Table Depth ----------- - Rock Size Distance to nearest: Well ---? '''----------------------------Foundation--------------------- Prop. Line ---------------------- REPAIR/ADDITION --------_-----------REPAIR/ADDITION(Prev. Sanitation Permit# _------------------------------------------- Date -----------------------------------) Septic Tank (Specify Requirements) __----------- ---- - -----------------------------------------!------------- Disposal Field (Specify Requirements) _-------- """----""-"------------- - -------------------------------- 1 ------------------------------------------------------------------------------------------------------------- -------------------------------------------------- ---------------------------------------------------------- (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, t shall not employ any person in such manner as to become subject to Workman's Compensation laws of.California." Signed — ----------------------------- Owner By --------------- Citle ------------ -------------- ------------------------- ------------------ (If other than owner) FOR DEPARTMENT USE- ONLY APPLICATION ACCEPTED BY - -C ------ --- -------------- ------------------ DATE -------------------- BUILDING PERMIT ISSUED ------------------ --------------------------- -----------=- ----------DATE .. ADDITIONALCOMMENTS --- ------------------------ - ---------------------------- -------------------------------------- ------------------------------------------------------------------------------------------ - ----------------- -------------------------------- -- Inspection by _= Date SAN JOAQUIN LOCAL HEALTH DISTRICT n E. H. 9 1-'68 Rev. 5M