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FOR OFFICE USE: APPLICATION F9R SANITATION PERMIT 7/ — -------- 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/LOCATION . s ----s- ------ � `1 � r-L--�-----�-"r� tNSUS TRA T --------- Owner's Name �. � � - ------------------------:--------------- Phone / C City . `S C Address ( -n ��J----/--- -- x Contractor's Name -------- 1-------------------------------------------------------------.License # ---------.-- ----------- Phone ------------------ Installation will serve: Residence XApartment House❑ Commercial :[]Trailer Court l❑ Motel ❑Other -------------------------------------------- Number of living units---- Number Number of bedrooms ---7 Garbage Grinder ------------ Lot Size -- ------�'e 2 --------- Water Supply: Public System and name -------------------------------------------------------------------------------------------- -----------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan [E—'-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.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) rb PACKAGE TREATMENT f ] SEPTIC TANK [ I Size------------------------------------------------ Liquid Depth -------------------------- Capacity -------------------- Type -------------------- Material--------- -- No. Compartments ------•----------= d ' Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----- ----------------- LEACHING LINE ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------------------------- 'D' Box -------- --- Type Filter Material --------------------Depth Filter Material --------------------------------------.----- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -_-_-_---------...... ti SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---- ------------ Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well --------------------------------........Foundation ------------- Prop. Line _--.-----_-......-_ (REPAIR/ADDITION rev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 pecify Requirements) )- O --- tnDisposal Field (Specify Requireme - ---------------- ------ r (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done irk 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 perform anc of th work for which this permit is issued, I shall not employ any person in such manner as to become ub'ect or an's mpeniation laws of California." Signedx-.- ---- ---- ------------------ -------------------- Owner ' BY -- -------------------------------- ------------------------------------------------------------ Title ----------- ------------------ - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------ DATE --------07-1-71-1--------- ------ - BUILDING PERMIT ISSUED ------------ --- --------DATE ---- ------•------- - ADDITIONAL COMMENTS ------------------------------------------------------------------------------------ ------------------------------------ ------- ------------------ ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ---------------------------- -------------- ----- ---------------------- -------------------------------- - ---------- ----- Final -- - /4� Final Inspection by. = ---------- ------------------ Date - - --- ------------------- W JOAQUIN LGCAL- HEALTH DISTRICT E- H_ 9 1-'68 Rev_ 5M