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FOR OFFICE USE: --------------------- -- Permit N APPLICATION FOR SANITATION PERMIT Q7 jy mo. --=- ---r --------•- (Complete in Triplicate] -------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 _with -/�County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. j ._ (d�Gl' -�� eNSUS TRACT ------ &------------- Owner's Name ----- ....... ; --------------------------------------- ------ Phone Address -- --- -----�r_- n7S CIR--------- City --- /1�1� -r -----------------------------Name -------- Contractor's Name ---- _- ,S- � -- Phone Q/per+ Installation will serve: Residence)<'Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other --------_:---- --- --- - - - - - r Numbe=r of living units:_.__)"< Number of bedrooms -- _Garbage Grinder A�!a.-_._ Lot Size -��-.-�_--5--- ------------ Water Supply: Public System and name ------------ ---------------- ----------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam X Clay Loam ❑ Hardpan E] Adobe ❑ Fill Material WOW-__ 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,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size------------------------------------------------ Liquid Depth ----------------_----.----- r Capacity -------------------- Type -------------- ---- Material-- --------- -------- No. Compartments ------------ ~ Distance to nearest: Well ------------------------------------Foundation -.-------.------------ Prop. Line ---------------------- LEACHING LINE [ l No. of Lines ------------------------ Length of each line---------------------------. Total Length -_----_-_-------__----•_--- 'D' Box --.----.--.- Type Filter Material --------------------Depth Filter Material --------------------.--_-----_-_-_--__--_._ Distance to nearest: Well ------------------------ Foundation -------------.---------- Property Line ------_-----__--_._____ SEEPAGE PIT [ f 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 Tank [Specify Requirements) _ Di sal Field (Specify Requirements) ---- 4"'C---------- ------------------------------------------------------------------------- 1 - ------------------------- ! r ')idthis --------------- [ �Oaw existing and requirddition on reverse side) I hereby certify that I have preps 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, 1 shall not employ any person in such manner as to be su 'ect to�Woprk an's Compen tion la of Ca ornia." Gwrm.,- BY - ----- ------ - ------- ----------- -- --'-4'� --- f s Title --------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By -------------------------------------------------=---------------------- DATE ----- BUILDING PERMIT ISSUED ------------- - ------- --- ---DATE ---- --------------------------------------- ADDITIONALCOMMENTS --------- ----- ---------- --------- -------------------------------------------------------------------------------- -------------------------------------- ----- - ------------------------------------- --- -- -- ------------------- - ----- ----- ------------- -------------- ----------------------------------------------------- Final fnspec Date �� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M