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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ?.VA- �o!,,A__ _*oil 7 ------------ ---- -------- Permit No. (Complete in Triplicate) ------------- ------- -- -7 ------7---------------- This Permit Expires 1 Your 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 applicati6h" is made in complian e with County Ordinance No. 549 pcl exi�tin RK;gle and Regulations, a -,--.0 NS S TRACT S S ix-_ JOB ADDRESS/LOCATIO --------- ----------- - KN TRACT- -------------------------- IM Phone Address - ------------------------------------ Owner's Name -------------------------- -------------------------------------- Contractor's Name --- License #C7_C_P11Z7_ Phone ------ �01 .- ---ce�- -- �. City--- --------- -------- Installation will serve: i Resiclence�rApartment House-E] Commercial :C]Trailer Court ID Motel F-1 Other -------------------------------------------- Number of living units:.___I __ Number of be4kooms ____.Garbage Garbage Grinder-441---- Lot Size ....... Water Supply: Public Syste'm and name --------W-1 ........ ------------ - --------------------------------------------------Private 0 Character of soil to a dept.' of 3 feet: Sand'El Silt E] Clay ED Peat E] Sandy Loam ,E] Clay Loom E] Hardpan E] Adobe k Fill Material ------------ If yes,type ------------------ ---------- (Plot plan, s4owing size 101f lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: iNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK [ ]4V/S ---------------------------------- Liquid Depth ----------------------_- Cacpacily -- - ------------ Type -------------------- Material_ ----------- No. Compartments --------------•------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- ` r LEACHING LI E NoI . of Lines _-_____/-___-------- Length of Aach line._----9_-41------------ Total Length ----4___p------------- 'D' Box 41d Type FilXt I e ir!�a 1. Depth Filter Material _/115�7_----------------------------- r,--------_ _ /11 le- ------------------ Foundation ---------------------- ------ illstance to nearest: Well ----- S 1 __14 D r unclation Property Line ... p l_ SEEPAGE PIT Dd th t , ---------- Diameter ------- Number --------- ------------ Rock Filled Yes No C] Water Table Depth - ---------94�__,o--------- -Rock Size ----a� "" --------------------- Di J! -stance to'nearest; Well _111--leo---- ------ Foundation _-Z!�_ ------ Prop. Line ...................... REPAIR/ADDITION(Prev. Sbnitation Perrnit# ------------------------------ Date ---------------------------------- 11 SepticTankA(Specify Requirements) I---------------------------------------------------------------------------------I------------------------------ ---------------------------- DisposalI'lld (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ - --------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify thbt I have prepared this application and that the work will be done in accordance with San Joaquin y. C;Unt , .1� - Y.Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifi s the following: 4"1 certify thatrlin the perfo!"I ance of-the work for which this permit is issued, I shall not employ any person in such manner as to become subi;ct to Wc*IlIrI rkman's Compensation laws of California." ned ---------- By -------- -------------- ---- - Title ------ 41; (If other t an 11 owner), -- --------------- --------------- Owner 9 - -------- - --------- --- - --------------- - A 0 FOR DEPARTMENT USE ONLY APPLICATION(ACCEPTED ------------ ---------- DATE ------- 1[ :-------------- ------- -------------------------- BUILDING PERMIT ISSUED:1---------------------------------------------------/------ -----DATE ------------------------------------------- --- -------------------------------- --------- ADDITIONALCOMMENTS !I------------------------------------------------------- - --------------------------------------------------------------------------------------------- ------------=----------------------------.---------------------1[----------------------------------------------------------------------------------------- --------- ---------------- ---------- --------------------Al-------------------------------------------------------------------------------------------------------------------------------------------------------------- I) . all -----=----------------71---- ----- -- ------------------------------ ------------------------------------------------------- Final Inspectio'n' by; --- -- - -------- -----------------------------4----------- ------------------------------------- - --------------------------( -1-1-----------------11------ Date -----1----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-�68 Rev. 5M