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�- FOR OFFICE.USE: I�' i iPPLICATION FOR SANITATION PES _;T ------ ---------------------------------------------- permitNo: - (Complete in Triplicate) _ -1---------------------- Date Issued sued -�-�__.__. --------------------------_--------_ -----------_--_--_- This Permit Expires 1 Year From Date Issued 71cr�ichecl. • � 3 Oss 070-0(Apation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein deThis application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. /,_--Q _ �lWrENSUS TRACT __.. "_- ..---- JOB ADDRESS/LOCATION ._��4'0----�-,'--0 --`-- -- - -- I Owner's Name a-- --------------� ---�----- ------------------------------ -------------------Phone ------------------------------------ Address ,(-� /--^---------- City Contractor's Name / _d- _ _1� --------- -------.License # -------_-------------- Phone ------------------- . ---. -- Installation will serve: Residence ❑ Apartment House❑ Commercial:❑Trailer Court C] Motel 90ther _ "�Q �� -,11C��ot S ze ��_- ------ ------------------ ----- --- - - 0/- _' Number of living units:------------ Number of bedrooms -------------Garbage Grinder s----------- Water Supply: Public System and name --------------------------------- ----------------------- --------- ---------------------------------- Private ❑-- Character of soil to.a depth of 3 feet: Sand'❑ Silt.] Clay ❑ Peat Sandy Loam -❑ Clay Loam ❑ N� 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer isavailablewithin 200 feet,) ' � �---- � � Liquid Depth ----PACKAGE TREATMENT ( ] SEPTIC TAN � --------- /Xlao r Capacity Type _A�!� ateriolCompartments Distance to nearest: Well ---1490 _ _. -________________Foundation _ _________ Pro .. Line -..�__-:_--__-__ EEAGF�) No. of Lines of each line 1�� Total Length ----------- 'D' Box --- Type Filter Material -- 04='g---Depth Filter Material . _________ . Distance to nearest. Well -----/,co__'_-_-_ Foundation ----10 f________ Property Line __�............. i SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Yes ❑ IQ -_________ Rock Filled No WaterTable Depth ----------------------------------------------- Rock Size -----------------------_-------- Distance _Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------..----_---- � REPAIR/ADDITION(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: "I certify that�int . erforma of a work for which this permit is issued, I shall not employ any person in such manner as to become bE ' to Wo met'n' m{a aws of California." IV Signed --- r -_ -Y ----------------------- Owner BY ------------------------------------------ - ---- ---------------------------------------------------- Title -------- --------------------------------- -------- ---------------- (If other than owner) �OR�yDE�PARTMENT USE ONLY s� APPLICATION ACCEPTED BY -` ------------------------------------------------------ DATE --�'} ----J------------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------=--------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------- ------------------------------------------------------------------------------------------------------------------------------------------ ----- ----------------------- ---- -------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- - - - ----------------------- -- -------------------------------------------------------------------------------------------- - -- ---- - - ------- --------- _ _ Date �r t - --- ----- - -- - ----- --- -- ----- Final Inspection by: __-- fit --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M