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d 1 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I ---------------�f _._:..___...........................--- -•-=------ .._. Permit No. -• - - •_ _------------------ �_ (Complete in Triplicate} ----------------- ............................... This Permit Expires 1 Year From Date Issued Date Issued i 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 aril! Regulations: JOB ADDRESS/LOCATION �o,..� ,T_t 1.'- 9qJ ,!''4"._....CENSUS TRACT ............. Owner's Name ._4---t_0111 .asY--- E.Q.------ _....---------------- ------- ........... ._._-..__..__Phone ------ --•-----............... _......_ Address .-._. City Contractor's Name _ fi"-t- iqi� _--------- ....... License # ... Phone r Installation will serve: Residence gApartment House❑ Commercial ❑Trailer Court 0 a Motel ❑ Other ........ _ .......... ........... Number ofr Diving units:. ._ Number of bedrooms -3 -------- Garbage Grinder .t'JLP_... Lot Sizer__.___. _ tWater Supply: Public System and name ----------- -------------- -••------------ .--------_------------..---------- . Private ja( t Character of soil to a depth of 3 feet: Sand Silt Clay Peat Sand Loam Clay Loam P ❑ ❑ Y ❑ ❑ Y ❑ Y' ❑ ' Hardpan ❑ Adabelg Fill Materia( ..._..____ If yes, type .... ------- . _.--_.. a(Plot plan, showing size of lot, location of system in relation,l 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 [ 1 SEPTIC TANK[ �' Size ----- ------- ------------ --------- Liquid Depth .----- ----.---•-_---__--- Capacity -------------------- Type --------------= Material ------------•- - ... No. Compartments --------- -ZIV Distan � to nearest:, Well --_.,__..Foundation,- -------------------- Prop. Line ...... LEACHING LINE � r [ l No. of�lines ------------------------ Length of. each line...•--------•--.---,•.•--... Total Length J D' Box Type Filter Material ____Depth Filter Material 'Distance to nearest: Well. •___ Foundation"------ ,-_. . Property Line ---------------------- SEEPAGE - SEEPAGE PIT [ j Depth .__.�-_.,_.._.Diameter__ dumber .------------- .__._.__".:.r Rock Filled Yes ❑ No ,[j s Water Table Depth . ............. --------------------------- Rock Size ........ _..---_-----•-------- Distance to nearest; Well .............. .'_,....................... Foundation .................... Prop. Line ..._.,.._-....__...-- REPAIR/ADDITION (Prev. Sanitation Permit # ................... Date _.----- ...:.................... ...) Septic Tank (Specify Requirements) -------------- -------------------------- Disposal -----------------• ----- Diissposal Field (Specify Requirements) ��rt -.. ...... ..._.1_...._t "t rr_.-!._!.__/•_J J 8 --------- ---------------------- ----- - - (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 ollowing:"I certify th in the performan the work for Fs this per it is issued, I shall not employ any person in such manner as to beta a subject ,o ork Co! pens of Cali; rnia." Signed -E"1 G--s•--t BY ............. ...,._. Title'71 :. ------ (If other than owner) d FOR DEPARTMENT USE OXY APPLICATION ACCEPTED BY __-----_............ _....... __-- _ T DATE .. ........ _ ...... BUILDING PERMIT ISSUED .. - __DATE ---------------------------------.._....__. ADDITIONAL COMMENTS + ........................... ---• ----- ----- ( - - ------ [ - i ; `- ._ Final Inspection by: _. .._-..,-, f� r. Date .-• n__1 t SAN JOAQUIN LO L HEA' D RICT I E. H. 9 1-'68 Rev, 5M• (f o �'"