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FOR OFFICE SE: o APPLICATION FOR SANITATION PERMIT � _. Permit No. - _ =. ---. O (Complete in Triplicate) - - ------- t ----------- ;r Date Issued This Permit Expires 1 Year From Date issued 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations- --- egulations: JOB ADDRESS/LOC TION . f --- CENSUS TRA�C/T7 - Owner's Name _ _ ,-_--_-c- ---- --- - - ------------------------------------ --- ------Phone ---{--/-2- /,57 Address _ 741 - �,.�/y� City -- - --------- -------- Contractor's Name _____ ---------- - License #AS-W— _�---- Phone R0'3� -Y Installation will serve: ResidenceXApartment House❑ Commercial :❑Trailer Court il] Motel ❑ Other -------------- -------------------------- Number of living units:_-- """-_ Number of bedrooms __=7__.__Garbage Grinder ----- ---- Lot Size --/ - J----------------- Water Supply: Public System and name -------------------------------------------- ---- -------------- "--------r------- ---------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobex Fill Material ------------ If yes,type--------- -------------------- (Plot plan, showing size ofTlot, 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,) v PACKAGE TREATMENT ( ] SEPTIC TANK f ] Size------------------ ------------------------- Liquid Depth -------------------------- I Capacity -------------------- Type -------------------- Mater ial.� ------------'------ No. Compartments ------ -----------_-- Distance to ,nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------•------_--.----- LEACHING LINE [ ] No. of Lines ------------------------ Length of each linea------------------------- Total Length ------------------_-------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----------------------------- Distance to nearest: Well -----------------------" Foundation ------- ---------------- Property Line -----._.__-------------- �, 'SEEPAGE PIT [ ] Depth ------------- Diameter ---------------- Number -.------f------------------ Rock Filled Yes ❑ No I❑ k Water Table Depth ------------------------------------------------Rock Size --------- a-------------------- E Distance to nearest: Well ------------------- " -_-_..Foundation --r-- -------------- Prop. Line -------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) s Septic Tank (Specify Requirements) -------------- x d2� -1 --------- - Disposa! Field (Specify Requirements) _-__-- "" ___ -_- - - ___._.. -"_--._ - � - - - -- ----------------- --------------------------------------------------------------------------------------------------------f------------------------------------------------------•------------------------ --= --_--- -------"--------------------`----% - __ -""__--------- ---------------------------------------- (Draw --- - - - ---------------------------------------------- f i (Draw existing and required addition'on reverse side) l I hereby certify that I have prepared this application and that the work will be done in accordance witlk.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, 1 shall not employ any person in such manner as to be me sublect t Wor an's Compen tion laws of California." Signed .......... -- --- Owner r BY ----------------------------- - - - -------- ----------------- Title ----------------------------------- ------------------------------------ (If other than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -- ----------------------------- -----------. DATE ------------------------ - ----------- -- ----- -- - - BUILDING PERMIT ISSUED ------ DATE ADDITIONAL COMMENTS ------ - ---- --- - --- -------------------------------------------------- - ---,-------------------------------------- -- ------ ---------- - ai- ------------"_____-_-___--.------"--.---_ J b -------------------------------------------------------------------------- ----------- ��— - - - ------------ Final Inspection by: --------------------------------------------------------------------=-----------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M r