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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------- Permit No. .-'7-s"__7.3-3 ` - (Complete in Triplicate -------- ----------------------------------------------- Date Issued ___.- This Permit Expires 1 Year From 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 ON Z_�-- 1. lvf- --------- CENSUS TRACT n ---------------------------------------------------- --------------------Phone ------------------.----------------- Owner's Name ----- /2 -------------- - Address -------i� ------ City --- --------------_ ----------------- ------- ---------------- Contractor's Name / �'_ ------License # � _$ Phone -------------------------------- It,installation will serve: Residence ❑ Apartment House f-I Commercial :❑Trailer Court ;❑ Motel ❑Other,. _ -- _ __ Number of living units------------- Number of bedroomsrbage 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 ❑ Clay Loam Hardpan ❑ 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 feetJ ell X PACKAGE TREATMENT ( ] SEPTIC TANK �}(� Size s __� �.e+ ---------- Liquid Depth --__ _________________ 1 l a-Q �_ y f" Capacity id 0-7 Type Material ---No. Compartments N i r V } Distance to nearest: Wel! ._____-____S_m_[---------------Foundation _._�__�__----- Prop. Line ___.-S_ ...._____. LEACHING LINE ( ] No. of Lines Y----- Length of each line---------1'_0------------ Total Length :______/_6.0...__...... 'D' Box ------------ Type Filter Material ____�!2______Depth Filter Material ------- -------________________ ---- nearest: -----1_'--- -----•--•----- -SEEPAGE PIT [ ] Depth -------------------- Diameter -------=-------- Number _-----.--------- ----------- Rock Filled Yes © No i❑ Water Table Depth _-_ _._ -- -- ------= -------------------------Rock Size ----------------- •------------- Distance to nearest: Well ----------------------------------------Foundation .------------------ Prop. Line ----------------. REPAIR/ADDITION(Prev. Sanitation Permit# --------------- --------- ----------------- Date -----------.____________---------:1 ` ' Septic Tank (Specify Requirements) ________________ DisposalField (Specify Requirements) --------------------!` -------- ------------------------------------------- ------------------------------------------ --------------- ---------------------------------------------------- ----------------------------------------------------------------------- ----- -------------------------------------------------------•------------------------------------------- 1 (Draw existing and required addition on reverse side) 1 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: "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 become subject to Workman's Compensation laws of California." Signed ------- ---------- ----------- ------------ Owner --- BY --------------------------------- --------------J",.`1-"t J' "'� '� : Title ------�-------------------------------------------- (If other than owner) , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -__ -___ _ __,__._____ - - -- ------- ------------------------------------------- DATE --- "'f BUILDING PERMIT ISSUED ----------------------------------------- --------- -- -----------------------=--------------DATE -----------±------------------------------- - ADDITIONAL COMMENTS ------------------------------------ ------------------------- - ---- ----------------------------------------------- --------------------------------- -----•--- -------------------------------------------------------- ------------------- ---------------------------------------------------------------------------------------------------------- ---------- ---------------------- -------- -------- ---, -- - Final Inspection b --Date ----- •, SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,, '