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FOR OFFICE USE: P,Ir-7� APPLICATION FOR SANITATION PERMIT �/,�, 1 �^.._-- ------------------------------------------- ----------- ` Permit No: _. _ (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 per 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/LOCATION7 � a , ------------------ Owner's Name ------------- -�- - - ------------------Phone - -------- Address ------ ---- -- ------------------- City -- Contractor's Nome --------------------------------------------------------------------License # ------------------------ Phone ------------------•----------- Installation will serve: Residence (Apartment House❑ Commercial ❑Trailer Court ;[] Motel ❑Other ------------------------------------------ Number of living units----- Number of bedrooms _._____Garbage Grinder 7 a_.__ Lot Size /0_f_f_ 6 Number Water Supply: Public System and name -----------------------------------------------------------------------•---------------------------------------Privatex Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay-Loam Hardpan J3j 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.) {+V ° NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V PACKAGE TREATMENT [ ] ,qj _______________ Liquid Depth SEPTIC TANK Size_ ___z-�_�.�':�__________ ------- No. Com ---------------_ Capacity 1� fid___:__ Type _: ` Material____________ partments ' Distance to nearest: Well _47�L'+-------_-------------Foundation -------------.Prop. Line ........ LEACHING LINE X1 No. of Lines ---:2 Length of each line.____I�...____________ Total Length /(7-0................... 'D' Box Type Filter Material &_f3'_--------Depth Filter Material ----�ff----_____.--.___________________ + Distance to nearest: Well _ 0 - __________ Foundation fU__--____________ Property Line. ��_�'.............. [ p 0Water Table SEEPAGE PIT De� th ___�_�'______ Diameter _�_3________ Number _____�__._______________ Rock Filled YesV No i -- � ------- Rock Size -------y----- ---------------- -- =---------- Distance to neae ----- ------------- ----- est: Well _1�_-______.__ ----------------Foundation _.lQ_--- ------ Prop. Line _ -. ----------- REPAIR/ADDITION(Prev. Sanitation Permit# .------_----------------------------------- Date -----------------------------------) Septic Tank (Specify Requirements) -------------------------------------------- --------------------------------- -------------._-...--------------------------- Disposal Field (Specify Requirements) ----------------------•---------------- --------------------------------------------------------------------------------------------- --------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reyerse_side) _ _ -- -- I hereby certify that I have prepared this application and that the work will be done in•accordance with San Joacluln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin'Local Health District. Home owner or iicen- 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 Signeas to become t to Wo a plob mpens t' laws of /NTUSE d ff= -- ----- ----------- --- r By ------- ------------------------------------ --------------------------I---- ----------------------------------------------------------- ---------- (If other than owner) FOR .DEP RTNLY APPLICATION ACCEPTED BY� -- ------------------------------------------------- DATE ------------ BUILDINGPERMIT ISSUED ----- ------------------ ---------------------- ----------------------------------------------------- ---DATE ------------------ ------------------------ ADDITIONALCOMMENTS ----------------------------------- -------------------------------------------------------------------------------- ------------- ------------------------------------------------ r--------------------------------- -------------------------------------------------------------------------------- ------------------- ------ --------------------------- --------- ---------------------------------------- - ------------------------- --------- ------------------------- ------------------------------------------ �= Final Inspection by: _ Date ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.