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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: �J�__ 7 1 JOB ADDRESS/LOCATION 6_A P0__-,- / /�------- ------ ---- ---------- ------CENSUS TRACT - --- --------------_--- Owner's Namey�U � = � -------------------------------- --Phone --------------------••-------------- Address /�1 _.�� rr-i_ - --------------- City Cc - Contractor's Name --- ___��-� # IYZA}'Y_ Phone - - Installation will serve. Residence ❑Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ----- ------ ------------------------------ Number of living units:------f---- Number of bedrooms ____Garbage 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-6 Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of loft, 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 .. --____,_- -.__-------- Liquid Depth -�---------------.----- Capacit _ �_� _ Type f Material__ No. Compartments r--________________ Distance o...nearest: Well ________-5 _ -----------------Foundation _.------- Prop. Line ----- _ - ___ LEACHING LINE No' of Lines ---�______________ Length of each line--------F0- --------------- Total Length __1k!6------------------- D' Box --- Type Filter Material -___ ,_ _______Depth Filter Material _��/_p_______________ __________________ Distance to nearest: Well ---4'40__ ____________ Foundation ----------- Property Line ------------------- [ p S t _--__ Rock Filled Yes � No C SEEPAGE PIT �' Depth __�_ .__._.__ Diameter _ 3�_____ Number _-__�__�'_�_ _ Water Table Depth ----------------/a-a ---------------------Rock Size --/,/ /_3--------____-- Distance to nearest: Well -------If?A------------------------Foundation -----G.E-__1---- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ___________________-__________--__) SepticTank (Specify Requirements) ------------------------ -------------------------------------------------------------------------------------_1----------------------------- Disposal -------- ------------------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 in the performance of the work For which this permit is issued, I shall not employ any person in such manner as to beco subject to Workman's Compensation laws of California." Signed ---- - - --------------- Owner -- --- ----------------- BY = Title ------- - ��-------------- '(If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .- - - - - - ---- ----- -- - -------------- -----------. DATE - - ----------- -- - BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS - ------------------------------------------------------------ -------------------------------------- ---- ---- -- ------ I - -------------- --------------------------------------------------------------------------------------------------------------------------------------- -------------------- ----- ---- ------ ---- - - ------- ----- ---------------------------------------------------------------------- ------ Final-Ins-Final Inspection by: _-._ -- ___..Date `�_____� ._ --__ ---___ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M