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FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT -------------------------------------------------- Permit No. . (Complete in Triplicate) This Permit Expires 1 Year From Date Issued _________________________________________________________ Date Issued �-_6� 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 c lia a wrilb County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .--_- _-- __-- _ _Q1's�v/1_ 41 - l_'-------i s�Cll -e ---.-....CENSUS TRACT ------- ----------- • i r 1 / - ----�W Phone Owner's Name ------------ ---- ! Address ----J ^ �zcp - ----- Cit q� -------------------------------------------------- Contractor's Name CC tl r ___---sem °r'��__�-_�----------License # ------------------------- Phone ---------Tl----.-- Installation will serve:/ Residence Apartment House,0 Commercial ❑Trailer Court ❑ r Motel ❑Other ---------------------'---------------------- Number of living units:------!-__ Number of bedrooms e!!-;------Garbage Grinder ------------ Lot Size 115?e___'S______------( _____--__- Water Supply: Public System and name --------------------------------=------------------------------------------------------------------------------Privat4< Character of soil to a depth of 3 feet: Sand'❑.p Silt 0• Clay;'❑ Peat❑ Sandy Loam -X Clay Loam Hardpan 0 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,) -r--Z 0 2 02 A PACKAGE TREATMENT [ ] SEPTIC TANK Size__� 12 � ------------------------- Liquid Depth - Material-4-X- 0- --- f _ Capacity �-�_4 0 -- TYpe --r------------- Material Qr7u�tt�;------ No. Compartments ---/-C�------.•------- �/ Distance to nearest: Well Z_ j ----------------------- ________ ____________Fou d tion __/I9--------- --__---___ Prop. Line -----Ila---._-__ _16--- ---------=-�� L'erigth of ea�h Tine 7 __p______.-__--- Total Length ----_--�-cz`�_�/� ' LEACHING LINE No. of-Lines y- -* 'D'-Box ---�_____ Type Filter Materials `�_C_Rk_Depth Filter Material ...1-17��________________________________ � - !�� s f Distance to nearest: Well �R_Q ------------- Foundation __1._0_____..________ Property Line ------ SEEPAGE PIT [ ) Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No .0 Water Table Depth ---- ''= ----------------------------------Rock Size -------------------------------- Distance to nearest: Well -------- ------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date ---------------------------------- Septic ---i---------------------------_Septic Tank (Specify Requirements) -----------------------------t_ Disposal Field (Specify Requirements) ------------- -_---_------------------------------------------ ------------------------------------------------ ---------- ------------------------------------------------ ---------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 bera bject W m nos:Com nation laws of lifornia."F Sign - ------ BY -: ----------------------------------------- -�------ Title ----- -------------------------------------- --------------------------- (If - - --- (If other than owner) FOR D ARTMIENT USE ONLY APPLICATION ACCEPTED BY .-- t_- '----------------------------------------------- ------------------- DATE BUILDING PERMIT ISSUED ----------- -- -------DATE _-------------------------------------------- ADDITIONAL ---.-----.-------- -- - ADDITIONALCOMMENTS -- ------------------------------------------------------ ---------------------------------------------------------------------------------------- ----------------------------------------- --- ---- ---------------- ---- ------ - =------------------ ------------------------------------------------------------------------------------------ y, -- ---------------------------- ---- - ---------- ------ - ---- - ---- - ---------------------------------------- Ik} ------ ------ ---- Final-Ins -- -------------------------------------------Date --- --------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M