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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------- -- - - Permit No. --7�' (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued _7' 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/LOCATION ._ //--f_!_ _____ �G ____ tu_ __.LCC��'_-------.----CENSUS TRACT Y--7-l_______________ Owner's Name Tf ----------------------------- Phon ------------ Address City ---- 1------------------------------ Contractor's =Contractor's Name --- # - 417�Phone Installation will serve: Residence ❑Apartment House,❑ Commercial❑Trailer Court ,❑ Motel ❑ Other _. SrtF'oo +C____C�3ccrrlTy� `'� Number of living units_____________ Number of bedrooms ____________Garbage Grinder ----------.- Lot Size _-__ -- T Water Supply: Public System and name ----------------------------------•---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ 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 is available within 200 feet,) E) PACKAGE TREATMENT [ ] SEPTIC TANK'[ 1 Size------------------------------------------------ Liquid Depth ________________________-- �K cSr"Gj Capacity -------------------- Type -------------------- Material---------------------- No. Compartments --------------------- i ante to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ...................... LEACHING LINE [ o, of Lines . s ' ----- Length of each line-------__ -__ ________ Total Len th [3 'D''D' Box�.c?:__ Type Filter Material _ _�__Depth Filter Material ____1, --------------------------- Distance to nearest: Well _.l7p__�______ Foundation -----LQ_'e------- Property Line ---:5------------------ SEEPAGE PIT [ Depth _.Q�_.•_-S---------- Diameter -4cf-_____ Number ......../---------------- Rock Filled Yes E� No ❑ Water Table Depth -------------------------------------Rock Size -- -- X- --�-- 6_1571 Distance to nearest: Well ....4d_-----___________________Foundation ____/©__ ____ Prop. Line _._-------.____-_-___- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) " Septic Tank (Specify Requirements) ----------------------------------------------------------------?------------!:2_11____-i___,• ------ ----,•.----- ,- ------------ Disposal Field (Specify Requirements) _ ___ ___ ------ �� r - -------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ----------- ------------------------------- �. (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 become ct to Work an's C mpe ation laws of California." Signed -------- ---- - - _____ -------- Owner BY ---------------- -------------- - ----- - -- .cue- - ----- ------- Title ---- - -------------------------- (If other than wner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------•---------------------------------------. DATE ----------- BUILDING PERMIT ISSUED -------------------------------------------------- - -------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS - ---- ------------------------------------ -------------------------------------------- ---------------- ------------------------ ----------•---------------- --------- --- ---- ----------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------- ----------------------- ---- ------------------------------------------------------------------- ---------- �Date + - ---------------- nbFinal Ins ectioSAN JOAQUIN LOCAL 1HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M