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FOR OFFICE USE: " - APPLICATION FOR SANITATION PERMIT ' = (Complete in Triplicate) Permit No. _-�o?-" -------------------------------------------- ' ---------------------_--------_- --- This Permit Expires 1 Year From Date Issued Date Issued _A-�7:1k. 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: t ` JOB ADDRESS/LOCATION ---- -CENSUS TRACT ur Owner's Name ......R0.0------ t�,/3 ------------------------------------------------------ •-------------------Phone Address ----- 8_ _ _ -------------- City - , - 19ARi�------- Contractor's Name ,r� f �4 /-- � -J License # 7 - 1 _- Phone • Installation will serve: Residence 2_)*P�artment House,[] Commercial ❑Trailer Court ;❑ Motel []Other I Number"of living units:---/------- Number of bedrooms ---` -----Garbage g Grinder __ --__ Lot Size - -�(-_ -------------- _ Water Supply: Public System and name ------------------- - ----------------_-----Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam j Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Material ------------ yes,type a ------ _ _---_ -- � (Plot plan, showing size of lot, location of system in ation to- wells, buildings, .etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 204 feet,) PACKAGE TREATMENT �f 7 SEPTIC TANK " Size-- _X�a`, `'..�-------------- Liquid Depth ----- -s-- ---------- Capacity f _____ Type 1E'[ l- Material---------------------- No. Compartments _--_ - LEAC t ` s Is stance to nearest: Well ------5.0---------------------Foundation --- �---- ----. prop. Line -----�_-_-:-_-... HING LINE No, of Lines ` F C-------------- Length of each lire-----�0--`------ ------ Total Length .____,2x---------------- 'D' ----__--_-----_ 'D' Box ---1_� ---- Type Filter Materia f rv/:�/Depth .Filter Material -----Jf� 1 � -.fes--------------------� . - ..._. ,j C .---- Distance to nearest: Well -_-- 9---------- Foundation _--1 Property Line .__CY--__------...... SEEPAGE PIT [ ] Depth ----- -------------- Diameter ---------------- Number ------- Rock Filled Yes ❑ No i❑ 1 Water Table Depth ------------------------------------------------Rock Size -------------------------------- 1 Distance to;nearest: Well ........................................Foundation -------------------- Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------- Septic ----------------------_--_------Septic Tank (Specify Requirements) ---=------------------------------------------------------------------------------------ „ Disposal Field (Specify Requirements) ---------------- ------- ---------------------------_------ (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: 6,,"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 orkman's Com ensati. laws of California." Signed Owner --------------------------------- By ----- --------------- ------------------ ------------ -- ------------------------------------------------- Title - - ------------------ ------- other than owner} l FOR DEPARTMENT USE ONLY �+ APPLICATION ACCEPTED BY ----� _---------------____•- / rte-- ----- DATE --- BUILDING PERMIT ISSUED ---- —� -"--- - ------------------------------------------------------------- --------------DATE - ------=----•------------- ADDITIONAL COMMENTS __ -.- -_ ` ------------------------------- t -------- ------ -- ------------------- -------- - ------------------------- -- -- ------- -- - --------------------------------- -- -------------------------------- Final Inspectio : .-- ------Date ---- l SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M