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OR,OFFfCE USE: ry0 APPLICATION fFOR SANITATION PERMIT -'3 ------ 7 z --I/3 7 •------ (Complete in Triplicate) Permit Na_ _________________ --. -- --- --------------------- --- --- ---------- This Permit Expires 1 Year From Date Issued Date Issued /. -/- 7 L- --- --- { 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/LOCATION ; - ' Owner's Name CENSUS TRACT _- �_ ._ . - �- -- -----Phone Address —City / - - -------------------'---- Name __.�,C�J �� ,. � ` ------------- Contractor's � -----�� ----- License # / 7� - �`�� ,-- Phone Installation Name serve: Residence,] Apartment House❑ Commercial ❑Trailer Court ;❑ k. Motel ❑Other Number of living units:-. ------- Number of bedrooms _� ____:Garbage GrinderN0_-- Lot Size , lla_r, l Water Supply: Public System and name __________________ ____ ___ j - - -------•- ---------- ---------- --------- _ Private ❑ ------- - - ---------- - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe A Fill Material ------------ If yes,type ---------------------------- (Plot __________________(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed oh reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if.public sewer is available within 200 feet,) PACKAGE TREATMENT �j /� P SEPTIY [P AN SizeLiquid Depth �. [ 7 Ca acit l U 'WTyp MaterialrNo. Compartments �C Distance to nearest: Well '"-____--_--_-____ Foundation /0------------ prop. Line _ _ __..______ r -- LEACHING LINE [ j No. of Lines ------------------------ Length of each line_--------------------.------ Total Length ----------------- _------- + 'D' Box ------------ Type Filter Material ' YP Depth Filter Material ---------------------------------- Distance to nearest: Well ------ - Foundation ------------------------ Property Line ------------- SEEPAGE -------- ---•----------- 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 ------------_"--- --------:--_:-,_) Septic Tank (Specify Requirements) ------A? . _' `: r/��,�,4 �✓� j!_ �/�� - j isposal Field (Specify Requirements) _________ -_ -------------------------------------------------------------------------------------------------------------- ----------- -------------------------- - -- raw 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 liken- � sed agents signature certifies the following: "1 ceirtify that in the performance of-the work for which this permit is issued, I shall not employ any person in such as to become subject to orkma 's Comp sation laws of California." manner Signed ----- Owner _ BY y x -- - ----------- Title FOR -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ".� - BUILDING PERMIT ISSUED ------------- -- -__"- -------------- DATE 1 -- 7- -- ADDITIONAL COMMENTS -----------------f-------------- --"-------- r DATE. --------------------------------------------------------------------------- = ------------------------ : - ---------- ----------- ------ ------------------------- :------------------------------------------- ---------- = ' ------------------------------- ------------------- f ------------- ----------------- -- ( Final inspection by: ---------------------------------------------Date --- ------- 7/ - -- 1 r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,