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0-Vo �f- f-f- Rd T FOR OFFICE USE: Il APPLICATION FOR SANITATION PERMIT --- - ------ --- - -------- --- ', Permi : -_-- a (Complete in Triplicate) t No ______ 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 icompliance with County Ordinance No. 549 and existing Rules and Regulations: l �� J __ = 4 10 JOB ADDRESS/LOCA7.ON . t ._ ENSUS TRACT -------------- ----------- 7- Own ---------- �Li; Q /�� ' � Y2 �-.T}oaf' T Owner's Names-- .`r - -------"z�� ------------Phone Address L 3"' t-- l ----�'--°L-------- --- - -- ------------- City !, "2.�3 fj�j'-� � -------------- �t t /. Contractor's Name i --` - -----------------------.License #,��l_ Phone .- -��,1_sf_�_�..... Installation will serve: f Residence'VApartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other „ Number of living units: Ill'------ - Number of bedrooms ---�--Garbage Grinder ------------ Lot Size ---=2 - ---- Water Supply: Public Syste _ m and name ------------------ Private Character of soil to a depth of 3 feet: Sand Ej Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.� it Hardpan ❑ Adobe ❑ Fill Materia! ------------ If yes, type _-________________ (Plot plan, showing size sof lot, location of system in relation to wells, buildings, etc.-must be placed on reverse side.) � NEW INSTALLATION: lNo.septic tank or seepage pit permitted if public sewer is available within 200 feet,] r PACKAGE TREATMENT [ ] '1f Xg'` - �� [ ] SEPTIC TANK Size----- ------------------- ------ Liquid Depth __.�__� __._,-------- Capacity -_r�a� l�___-- Type- Material 9i ---_ No. Compartments ___ -___f__.-_-- Di stance to nearest: Well -------oda_ _______________Foundation _.___�( _ _______ Prop. Line .__________ ..- . LINE [ ] Mo. of Lines -.--c2----_---____ Lengthl pf each ��e`_�G__��______---- Total Length --�4~ -------- LEACHING ._... D Box _ __ Type Filter Materia! 0 Yp - --- - ---- Depth Filter Material Dist\' !1 ance to nearest�Well __ _�� ________ Foundation f.---�-�-r------- Property Line ._rte ______________ 3 t it SEEPAGE PET [ ] Depth ___ Diameter _- ------ Number ............ Rock Filled Yes [ No i❑ Water Table Depth ---------------7-m�-------------- ---------Rock Size --- ------- --------•--- Distance to nearest: Well _____`r ______________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------••------------------) Septic Tank (Specify Requirements) -------- ---------------- Disposal Field (Specify "Requirements] ---------_---------------------------------------------- ___________ ----------------------- ----------- ' ----------------------------------------- ---------- ---------- ---------- --------------- ----------------------------------------------------------------------------------------- ---------------- ht,{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- Ised agents signature certifies the following: " `l„certify that in the performanee of the work for which this permit is issued, I shall not employ any person in such manner I as to become sub' t orkma sT mp ation laws of California.” Si nedC' ll --.- Owner 'Signed . 9 '"BY ----------- t--------------------------------------------------------- Title ---------------- ---------- ---------- -•---------------------- L of,other than`owner) FOR DEPARTMENT USE ONLY APPLICATION iACCEPTED BY ' _ _ . DATE --- --------74 BUILDING_PERMIT ISSUED'- ------------- DATE-- ADDITIONAL COMMENT '------- - ----- - e;a e __ _ :_ _ .__ ------ -------------------------------- - ----------- ----------- ----------------------- -----Final Inspection by: --------------------------------- ADate-- -- - - SJOAQUIN LOCAL HEALTH DISTRICT • E. H. 9 1-'48 Rev. 5M