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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- ---------------- -------••------- ---------- � Permit No: �, y. (Complete in Triplicate) } Date lssued•�_�--_,.?6=6i _- . This Permit Expires 1 Year From 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 compliancewiitth, JCounty Ordinance-No. 54 existing Rules and Regulations- 07 .) egulations: JOB ADDRESS/LOCATION. ��-•��- -- -----A----`"-�----------------- --- ----- ------------- CENSUS TRACT Owner's Name ----- ior-eel;Z __ Phone_- --- -- � ----------- Address 7a_so R � City - <-----------------------------------•---•------ Contractor's Name --__ OP ---------- -----.License # 95/0 "?'- Phone 7 � �t`�-•' Installation will serve: ' ResidencegApartment House❑ Commercial ❑Trailer Court A � `/ Motel ❑Other -------------------------------------------- ; Number of living units:-.--_/____ Number of bedrooms __=�2----Garbage Grinder ------------tLot Size __/e Water Supply: Public System andname ---------------------=-----------•--------------------------------------------- ---------------- ----- Private Character of soil to a depth of 3 feet: !Sand❑ Silt❑ ,,t Clay ❑ Peat❑ Sandy L am -❑ ; Clay Loam r 4.. Hardpan ElAdobe ❑' Fill Material ------------ If yes,type -------------------- --- }�' a (Plot plan, showing si a of lot, location of system in relation to wells, buildings,-etc, must be placed on revePse side.) I NEW INSTALLATION: }(No septic tank or seepage pit permitted if public sewer is available within 200 fee#,] t i'" PACKAGE TREATMENT [,] SEPTIC TANK'[ I Size-------------------•---------------------------- Liquid ,Depth ------------- ------------- 4 Capacity _ Type -------------------- Material----------- ---------- No. Compartments -----------•---------- t� Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------- :-------- LEACHING LINE .No. of Lines ------------------------ Length of each line---------------------------- Total Length --_---.--_--._..----. ------ Y 4 'D'�Box ------------ Type Filter Material --------------------Depth Filter Material --------------..------••---------------- -• ' -__ Distance to nearest.-.Well ________________________ Foundation ----___----_--- _ -- Property p ty Line ---.--------------•----- SEEPAGE PIT [ ] Depth _____.- -__' Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth"J-------------------------------•------------Rock Size ------------------- ------------ . . t Distance to nearest:Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- i i REPAIR/ADDITION(Prev. Sanitation Permit# --•----------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------------- -------------------- ----- ----------------- - -- -------------- ---- sem_ 2 � Disposal Field (Spe i f y Requirements) --�-------G�'-��-/:--- _ 4-_'ti-_ • --- ---3 - = --------- ---- (Dr 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----V- --------------- --- ---- ---------- - Owner Title --- (if other than owner) „ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----- -- '--- ------ -� - --------- DATE - � 5--- -'---- ---------------- -- ------------------------------ BUILDING PERMIT ISSUED --------------------- -----------------------------------DATE ADDITIONALCOMMENTS -------------------- ---------------------------------------------------- -------•------------------- ----------------------------------------------------------------------------------------- --------- ---------- ------------------------------------------------------------------- '� -------�------------------------.---------_-------------_____-----__----' - --------- y -------- ------------------------------------------------------ ---------------------------- ------------ -----.---_------------------_-______- _ _ - ------_-_-- ----------------------------------------- Fina! Inspection bY- Date +0{� a_ SAN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M