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34/ FOR OFFICE USE: 5, APPLICATION}FOR 'SANITATION PERMIT , - - --------------•----- ------- -- Permit No: (Complete in Triplicate) --------= -------------------------------------- Date Issued/� ._,_ --------------------- This Permit Expires 1 Year From 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 wit County Or inance No. 549 and existing Rules and Regulations: ADDRESS/LOCATION ._ , --� - ------ ------ ------- -- -------- ----------CENSUS TRACT --------------------------- JOB ��Owner's Name -----------C • -- ---------------•- •------------ ----- .- --------------Phone 7�� ------ ' _.v.5. Address _.- ' -° - -- ---- ----- - ---------- -----------------•---- -----------._. City -- --- -- -- �--------------------- �--------------•-----•------ Contractor's Name - ---------- - --- - -- -- --------- --- ` - ---License - ------- ------ ---- Phone _S-----_7".745 Installation will serve: Residence ❑ Apartment House Commercial:❑Trailer C6urt ,c3 , --- Motel ❑ Other -- ----- - - ---- --_21r----•---- °� Number of living units:___-�_____ Number of bedrooms ------ .__Garbage Grinder _________ Lot Size _-�!`=_ ------- --- Water Supply: Public System and name ------------------------------------------------------------------------------------------------------------- Private l ; Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 . x> . Hardpan ❑'-. Adobe ❑ Fill Material If yes,type.:---------=--=---- .. 4 �F (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 seeps pit permitted i rpul��ic sews fis available within 200 feet,) ,f PACKAGE TREATMENT [ ] SEPTIC TANK, Size__ _____4._-"�-- -----9------------ Liquid Depth --- -----_--.-------- r ,. Capacity __ d� Q _ Type'P9�IA� -Material_(fV9Q_FTrNo. Compartments )--________________ �1 istance to nearest: .Well _ ___ ______________Foundation _____I�__________ Prop. Line ------------------ LEACHING LINE No, af.Liynes ------- `-'_________•Length of each line-J" '_____.______ Total Length __�421.�------------- 'D' Box _-_�._. Type Filter:Material 1� Depth Filter Material C ............................... Distance ------ Foundation ____1 --.-______-_ Property Line SEEPAGE PIT [ ] Depth ___'________________ Diameter ---------------. Number ---------------------------- Rock Filled Yes 'E] No i❑ WaterTable Depth --------------------------------------------_.Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ____......_ .......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ________________-____________.-._-} 6 Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- ------------------- ----------------- ----.- i`sposaI Field (Specify Requirements) ----,-------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------•--------- ------------------------------- --:--t,, X----------- -------------------------------- ------------------- ------ -------- --- -----------" �__ =,,q•_,;—_..,,_(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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of alifornia." Signed -------- Owner By --- == ----- = ------------------------------- Title __ - (If ther than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- i. - --------------------------------------------------------------------------- DATE ----- le----- - BUILDINGPERMIT ISSUED ---------------------------------------------------•---------------------------------------=------------._DATE ------- ----------------------- �------- ADDITIONALCOMMENTS - --- ---- ------------------------------------------------------------------------.---------------------------- = --------=---------------------------- ------ - ------------------ ------------------------- ----- --------------- g Final;lnspecti0 - -----------------------------------------------Dae . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M