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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. . " ------------------- 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO TION ... �.5 S - - - - � -CENSUS TRACT ... Owner's Name ._ ------- -- Phone - Address _1a2 _� - - city l,�e�c� -- j.Z, Contractor's Name _ / -- --- - --..License # 02Sf 2_3---- Phone �y71- Installation will serve: ResidenceXApartment House❑ Commercial ❑Trailer Court Motel p Other----------- Number --------Number of living units:.__ .. Number Number of bedrooms ....Garbage Grinder .. .._ Lot Size ! xve C_ ----------------- -------------•----- 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 E] Fill Material -... ------ If es, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.( G NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) h PACKAGE TREATMENT ✓ r 9) SEPTIC TAN Size _ "9----------------------- Liquid Depth .... ............... Capacity��pL3.�... 7ypeP1ZQ�Q�Materlali_T~-- - No. Compartments - - ` Distance to nearest: Wellr •yy,,,,, -LLQ""�...----.--.--Foundation -- ---4.-.---- Prop. Lina LEACHING LINE No. of Lines ---- pp r Q __..... - Length of ea line_.!_�._.�Q. Total Length �J'�B�_..-"-_-- 'D' Box ----/--- Type Filter Material `�: /-Y Depth Filter Material ..._.`17.__ r - - �- Distance to nearest: Weil ....t..-._ Foundation __/4_--..__.."" Property Line r SEEPAGE PIT X Depth -4P-F-a�._�_-" Diamete3l0_.... ___ Number .___t3_.__._-�-"" Rock Filled Yes A No ❑ h Water Table Depth ..__ .. IK& " 9Q............ -�-- ----- ---Rock Size -'- --- - --- ---- r r Distance to nearest: Well _/46.-----"-----"""_-,-----_Foundation � .__._..___ Prop. Line k5 /!/�sv REPAIVADDITION(Prev. Sanitation Permit# --------. --------------------._..__.------- Date ----------------------------------) Septic Tank (Specify Requirements) --------____-----.-------------------------------------------------------------------------------------------------Disposal Field (Specify Requirements) --- ------------------------- ----------------- -------------------- ----- ------- ---- - ---- - --- - ---------- (Draw 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 licen- sed agents signature certifies the following: "1 certify that in the performance of a work for which this permit is issued, I shall not employ any person in such manner as to be a sub' ct to Wo an' ompensatio s of California." Signed _. - .._. __-- Owner -- ----- ------------ By ... -- - --------- -------- Title ------ -------- (If other an owner) -- --------- --- E RTMENT USE ONLY �. APPLICATION ACCEPTED BY ---- -- o- ----- ------------------------------ DATE -----�0 f ....... BUILDING PERMIT ISSUED _. ------- - - ---- ------------ ----r----- --------- -- -------------------------DAT E ADDITIONALCO TS ------- -- -- -- - _ --- - - --------------------------- - -----------------------�- -- --------- ------------- --------- �- --- �c- f - - ----------- ----------- ---- - --- - -------- --------------- - -------------------------- --------------- Final Inspection by: .---- --- - - --------------------------------- - - - ----------------------- _.-- ----------...Date --- ' N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M