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FOR OFFICE USE: j�f APPLICATION FOR SANITATION PERMIT , �G7-�---_- Permit No: ------------- (Complete in Triplicate) I --------- - -------------- ----------------------------- Date Issued -.6----------7This Permit expires 41�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 compliance wit County Ordinance No. 549 and existing Rules and Regulations: I .--. � --1 ------ -- --- - - ---- -- - _ - - CENS US`T18�AC7 --------- - ---------- JOB ADDRESS/LOCAI� N . � Phone ------- ----------• ---------------- Owner's Name ----- / � Address ------------ `�'/ City ---- Contractor's Name --_;__-- -------.License # ------------------------ Phone _-_J-- =-- -- �_ Installation will serve: ? Residence Apartment House❑ Commercial ❑Trailer Court -,E] 6-- Motel ❑Other _?---_ - ---------- --------------------- --- - S 1� �{ 31 -7 Number of living units:----- Number.of bedlr'ooms`_ _ -----Garbage Grinder -_ Lot Size ----__--�-_. _-.-_------------------------ Number -- - ----------- -- ----------------------------- ----- Private ❑ Water Supply: Public System 'and name ------- ------- - -- --- - Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ ClayLoam i t= Hardyan ❑ :Adobe'0 Fill Material ------------ If yes,type -------------C----- 4 f (Plot plan, showing size of r,,lot!'1Jca.tiorti of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: �— IVo sep#ic tank or seepage pit permitted if public sewer is available within 200 feet,) . t ' - PACKAGE TREATM-N7 C.1---tSEXTIC 7ANK'C-l._�.-.,--w� Size----------------------------------------- Liquid Depth - Capacity<_ _1 < 9- Type Material----------- ---------- No. Compartments r Distance to nearest: Welld _---Foundations_ Prop. Littre ---------------------- w^.r5 -------�------------------- ' LEACHING LINE �" No. of L'+nes -_---�� ___--_----- Length of each line------------�a------ Total Length -- -_ --- ----------- DBax ---�___,_ Type Filter Material ---Depth Filter Material ..----� �------..e______________________ �. ( � !� -- Foundation Pro a Line ------ ---•----....--- � � Distance'to neatest: Well ----� �_------ � I ------ ----- p rn!. � SEEPAGE PI7i C ] -Depth !f =_-Di`bmeter ---------------- Numb" Rock Filled Yes � No �i Water Tatiie 'Depth _ ..��------------------ --- Rock Size - ----------•- Distance to nearest::Well --------- ------- - ..--------Foundation -------------------- Prop. Line ---.-----------.-••--- i ` ------------------- Date ---- ', �' --------------1 l . REPAIR/ADDITION(Prev. San �# -------- -------�----- - I ----------- �-,- -------------------- ----------------------------- e Septic Tank (Spe # �RpquiYments)--------- ------------------ X Disposal Field (SV!fy Requirements) -----------------------------------------------------•--------------- -- --- --- (Draw existing and required addition on reverse side) l I hereby certify that rl 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 liven- sed agents signature certifies the Following: _ I YS-.. "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 beco subject to Workman's C pen tion laws of California." Signed ------------------- --------- Owner ----------------------------- Title ----- - ------------ - 10----------------- 17-- (if othei than owner) I f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - _-___-. �------- ~DATE . ; -�f, BUILDING PERMIT ISS.UEp- _-^ DAT ..: _:: l -- ------------- ---- -----..:------- - a _ _- ADDITIONALCOMMENTS ----------------------------------------------------------- ---•------------------------------------------------------------------------------- ------------------------ ----------------------------------- =�----------- ------- --------{- ;----•-- ------------------------------------------ --------------------------- - S--__--i ------�°--------°---------------- ----------------' _- -- � E i..•- Date -. f-= --z - Final Inspection by.. ------ F JOAQUIN LOCAL HEALTH DISTRICT ��- E. H. 9 1-'68 Rev. 5M ///