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, FflR OFFICE USE:, 'a - APPLICATION FOR SANITATION PERMIT - ------------------------------------------------------------- (Complete in Triplicate) Permit No: ._7J-�Z5 ----------------------------------- this Permit Expires 2 Year From Date id " ""- ssue p Date Issued Application is hereby made to the San Joaquin Local Health District for a described. This application is made in compliance with County Ordinance No . S49 and ex stingermit to constructnRulestafndtRe work egulations�ein JOB ADDRESS/LOCATION . Owner's Name --------:------- ---- CENSUSTRACT Address - �?`T�J ''; ---------- Phone :_ c '� i� Contractor's Name _ - c i ty ��" ------•------ ------------------------------------ _ License # --- Phone .�� Installation will serve: Residence ❑Apartment House,[] Commercial:❑Trailer Court ;❑ 1 i ` Motel ❑Other ---------- --------------------------- Water ------------- ---- -- Number of living units------------- Number of bedrooms ------------Garbage Grinder - -___-_ Water 5u I Public System and name - Lot Size PP Y� I Character of soil to a depth of 3 feet: Sand' Private ❑ ( Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe '[] Fill Material ------------ If yes, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed an reverse side.] �4 NEW INSTALLATION: ta {No septic-tank or seepage pit permitted if public sewer is available within 200 feet,] 0 PACKAGE TREATMENT ti ] SEPTIC TANK,[ ] Size-"__"______- Liquid Depth ---- ------••------- Capacity ----------------- TYPe --------�-- ------- Material------------R �: ---- --- o. Compartments ""-""."""_" Distance to nearest: Well ------------------------------------ Fou-ndation Prop. Line LEACHING LiNE [ ] No, ofLines— "1- %- -' -- - ------------------Len h of each line---_------------------ - --- Total Length 'D' Box ------------ Type Filter Mat Tial --------- g '• � ---- ------Depth Filter ateriaf -- -- -------------------------------------- '4___ - - '..� Distance to nearest: Well . --- -- --- .- Foundation r" .""."" - " -. -_ -. Property Line __ SEEPAGE PIT : = ❑ N � [ ] Depth -- ----------------- Diameter - _ _ Number Rock Filled Yes ---------- r `r Water Table Depth -------------- ` . --------------•------•----------Rock Size "" istance to nearest: Well ----- -------------------------------- Foundatia Prop. Line -------------- REPAIR/ADDITION(Prev. Sanitation Permit# ------ ." -_ �_�_/32 - ------ Date ----- Septic Tank (Specify Requirements) ------------- µ" Disposal Field (Specify Requirements) --/- ----:-tr---_--- �g'`)� h --------- -------- - �•" ---- - --f� -------- ------------------------------ - (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 Reg sed agents signature certifies the following: ulations of-the San Joaquin Local Health District. Home owner or licen- "I certify that in the performance of the work for which this permit is issued, I shall not employ any person. in such manner r as to become subject to Workma Compensation laws of California." Signed r1 _ - ------ -- ----------- ------ ------ ------- - -- Owner BY ---- J -----c.C� (if other t on owner) -------------- Title .----------------- ----- FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f -" BUILDING PERMIT ISSUED --------------i - _':------. ------ ---------------------------___ DATE _. � --- ADDITIONAL COMMENTS ------------------ - -------------------- --- ------ -- --------------DATE ----------------------------------------------- -- ------------------- --------------------- ------------------------------------------ ------------- Final inspection b ------- Y' �, �: ------------- ------- ------------ ---------------------- --- ------- - -- ---- ---- ---------------------------------------I--------------Dat------- ------------- ------- ------.Date --- -- -----------9- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M