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r0K OFFICE Ubc: APPLICATION FOR SANITATION PL,�IT ----------------------------------------------------- � 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 permit to construct and install the work herein described. This application is made in compliance with County Ordinan-eK(No. 549 and`existi g Rules and Regulations: JOB ADDRESS/LOCATION ---. ��$---FFS--------- - -------- _YJ y------- ---------- -----------------------CENSUS TRACT ---------_- ------------ Owner's Name _- t: ;rw9.. ° b_r. _L- 'ry"r = = - --------.Phone Address ----- <1- r- --- --------------- City ------------_-------•------------- a ♦ r L` Contractor's Name ..._ .,/ *$% ___ ___ ^.____... �.nnCcrrlicense #c5'.=. �-7._ Phone Installation will serve: Residence (Apartment House❑ Commercial ❑Trailer Court :❑ Motel ❑Other ------------------------------------------- - - .� Number of living units:..--/------ Number of bedrooms _._____Garbage Grinder )IP....__ 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 p Hardpan ❑ Adobe 0 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) \ PACKAGE TREATMENT [ ] SEPTIC TANK Size__ Liquid Depth --------- Capacity _ _Capacity _ )466---- Type Material No. Compartments ---Z .......... � \n Distance to nearest: Well -._-----457&0---------------__----Foundation r_P_--_.--------- Prop. Line ----`__------!-------- l� LEACHING LINE [ ] No. of Lines ------3-------------- Length of each line------ 5• ....... Total Length _.cX10------•---- 'D' Box .. Type Filter Material _-.H&'__4if...Depth Filter Material ------1? -._-_._----------------------- _ Distance to nearest. Well __570------------ Foundation -------- _ Property Line ....!67 SEEPAGE PIT [ ] Depth _------ Diameter _.-------------- Number __--- Rock Filled Yes ❑ No ❑ Water Table Depth --------- --------------- -------- -------------Rock Size ------------------- --------_-- Distance to nearest: Well ...-_.....:............_.----.--------Foundation -------------------- Prop. Line ._-...____________- REPAIR/ADDITION(Prev. Sanitation Permit# --------._..-._ --------------------- -.- Date ---------.------.____.------------) IN11 Septic Tank (Specify Requirements) -------- - -------- -------------------------------- ------------------------------- Disposal Field (Specify Requirements) ---------------- ---- ----------- ------------------- -------- -- ------ -------- - -- -- - ..----- -------------------------- ------------------- - ------- - -------- - ------------------------------------------ - -------- ---------------- -- --------- ---------- --- -/i ` rj7f t ( raw existing and re uired 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: "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 Workman's Compensati n laws of California." SignedOwner _.�- - - --- - - --- --� ------------------ Title ----- -_------------- ---- ---------- -- ----------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . . -------------- -. � ~7 DATE ._ - ---------- .� BUILDING PERMIT ISSUED -------------------------- - DATE ADDITIONAL COMMENTS ------- -------------- ------------------- - - --------------- ---- --------------- t - ----------_---_ ---- -------- --------------- ---- --- - --------- ---------- � - ------ -------------- - Date ---- ------ ----•--- ------------ -------------Final Inspection by: ----- ---- �i!_- 7SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M