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t m I. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----- ---------------------------------- -a' ' (Complete in Triplicate) ---------------------------- _ -� Date lssued --_--�-------- This Permit Expires 1 Year From Date Issues! ,,r-Y District for a permit to construct and install the work herein Application is hereby made to the San Joaquin Local Health described. This application is'made in compliance with County Ordinance No. 549 and existing Rules and Regulations: f JOB ADDRESS/LOCATION ----.-��f�--- CENSUS TRACT -------------------------- G � /;_ 9s Owner's Name ----- - - Phone - --- _-- �, .,Z ----------- -/ --y / - 62 City ; ----------------------- -----------------•- Contractor's Name . ------------- ----------=-------•License #a Pe Phone `_3.!! 4 Installation will serve: } Residence%Apartment House❑ Commercial ❑Trailer Court ;❑ `- 1 i Motel [:]Other ---------------`------------------------------ rt - kNumaer of living units----- Number of bedrooms _---sA__:Garbage Grinder ------------ Lot Size _-'�--�"-- - � ---•--- Water Supply: Public System and name -----------------------------------C-----------------------------•----------------------•----------- --------Private k � t kk Character of soil to a depth of.3 feet: Sand'El Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam I Hardpan ❑ Adobe! hill Material ------------ If yes,type --------------------------- .� - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must beplacedon reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { j SEPTIC TANK'[a . . Size----------------------------------------- ------- Liquid .Depth --------------- ------ . - ..----- -- 7 ----- Material---------------------- No. Compartments ----------- ---- Capacity -------------- - Type ---- Distance to nearest. Well ------------------------------------Foundation ----------------------.Prop. Line ---------------,------ LEACHING LINE I j No.6of Lines ----------I-------�--=.-- Length of each line---------------------------- Total Length -----------.--------------•- ( 'D' Box -----_.-----,Type Filter Material --------------------Depth' Filter'Material --------------------------------------- Q y' i Distance to nearest: Well ------------------------ Foundation ------------------------- Property Line. -------------- --------- SEEPAGE PIT { ] Depth -------- -" ---------- . Diameter ---------------- Num ber -.------ ------y--_-- --- Rock Filled Yes [] No .❑ WaterTable Depth -----------------------------------------=------Rock Size-------- -------------••---- Distance to nearest: Welf --------------__- -._--._Foundation ---- ------ Prop. Line _-.-.---.-..-....-__.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------- ------ -----} .74 1 ----------- Septic Tank (Specify Requirements) Disposal Field f=ield (Specify Requirements) ------ - --'------------ -� ------------------------------------------------------------------- -- - - ---------------- -- --- --------------------------------------------------------------------------------I-------------------------------------- (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 l 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." 41 Signed , - --- - ---- --••------ Owner -Title ------------------------------ ----------------------------------------- BYI�- -- (If other than owner) r DEPARTMENT USE,ONLY /y APPLICATION ACCEPTED BY --------- --- --------- --------- f -------------------- ------------. DATE ---- '---- ---------- --PERMIT ISSUED DDITIONAL C M NTSe. � " t"`s /'� / / C= --- - ------ A, ------------------------------- ------- - --- ----------------------------------------------------11 -------��`� -- - - ------- -- --- -- ---- -------------------- -- -----.Date "/,.t.r. ----------------- Final Inspection bY� ---- - --- -- -- - -.-+�."v---------------------------------.- --------- - �` - AI JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M