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FOR OFFICE USE: APPt1GATION FOR SANITATION PERMIT Permit No. ? {Complete in Triplicate) --------------------------------------------- ----------------- Date Issued - - ---------- This Permit Expires 1 Year From Date Issue l the work herein A lication is hereby made to the San oaquiinanoeaNiNteCounth DtytOrd Ordinance No. 549 and existing Rules rict for a permit to construct and tand Regulations: pp lication is made in comp) 11 described. This app SUS TRACT ------- �� / -------------------------------------:.--.CEN JOB ADDRESS/LOC -- - -- - - -- -------•-- ------ -- - ---Phone ------------------------------------ Owner's Name --- ---- City - - _ --- -p r Address -------- --- --� l� - --- -_--- ---.License # l��3�-- ---- Phone ---------------------- Contractor's Name ."-- - Residence [A Apartment House Commercial ❑Trailer Court ❑ installation will serve: ; i Motel ❑Other _.------------------------------------------ f Garbage Grinder .-__--_----- Lot Size ------------ I---------Number of living units:._________ Number of bedrooms ___ --------------------------------____-- _ ----_-private C� ------------------ - ------------------------------------------------------- Public System and name ------------ ----- Water Supply: Y Peat F1 Sandy Loam [� Clay Loam Hardpan Adobe'E]Character of soil to a depth of 3 feet: Sand❑ Silt o Clay ❑ k ❑ Fill Material . ----- ---- If yes,type ---------------------------- + buildings, etc. must be placed on reverse side.) ! (Plot plan, showing size of lot, location of system in relation to wells, V NEW INSTALLATION: [No septic tank or seepage pit permitted if public sewer is available within 200 feet, ! « S �X '• ._.Size---= --- --�-�'=--X-5 .�.----- ----- Liquid Depth ---- - --�'- PACKAGE TREATMENT [ ] SEPTIC TAMC 1 61 ►Jo. Compartments ---- - ----------- Capacity _ _ a-a- Type RMaterial -------- f _- --------------------------------. ---Foundation -----�0-{----- ---- Prop. Line _.�-•----�----•-- Distance to nearest: Well LEACHING LINE C No. of Liries __ -- - Length of each line_- ----� b�---------- Total Length _---- - ~ S #�_-------Depth Filter Material ----1-- __'_--------• ------------------"- 'D' Box ---_�------ Type Filter Material ---------- S - � Foundation ------�-��----- --- Property Line. ---•------•------:------ Distance to nearest: Well -_--_�0........ r Rock Filled Yes �- No 1 � � ---- a-X--1-n_ Number ------ ------ --------------, ., Depth ----- ----- - t Rock Size ---- 'Y '�--------- Wa#er Table Depth ---------------—4,0-----•---------- ------ Water 4, O-�----- Prop. Line ---------------------- Distance --•-- -Distance to nearest:;Well ______________,rp----------- Foundation ____.._. ' .� .-_ ..,-'-- Date --------------•------------•------) REPAIR/ADDITION(Prev. Sanitation Permit'. --------- ---- ---------------- --------------------------•--- Septic Tank (Specify Requirements) ----------- ----------- ---------"_:--- d, .r - ------------------------------------------------------'---.------_-- ecif Requirements) ------------------- ---------------- Disposal Field (Specify q ---------------- --------- ' ----- ------------------- = --------- - -- --------------------------- (Draw existing and requieed`addifion on reverse si e) I hereby certify that I have prepared this application and that fFte San Joaquin Local Health District.ork will be done in Homece 'th Son owner or l'�gcenn County Ordinances, State Laws, and Rules and Regulations sed agents signature certifies the following: "I certify that in the performance of the work far which this permit is issued, I shall not employ any person in suchmanner as to become subject to Workman's Compensation laws of California." T _ Owner _-v : _ Signed -- -------------------------- -- -_--------_._ ---� Title __- .. - -------------------- --------------- By --------------------------------------------- �� r �71`_t �•e - ��-- --- -.�-� � (If other than owner) FOR DEPARTMENT USE ONLY DATE . L � ------------ ------------ - ACCEPTED BY _ -----.--DATE ---------------------- ----------------------------------------------------------------- - =-------------------------- } BUiLDWG PERMIT ISSUED ------- -------------------- -�- ------ �---- - - ADDITIONALCOMMENTS ----------------------------- ----- ------ ----- ------------- ------- -�---- ------ �-- - -- ---------------- --- ------- ------------ ----------------------------------- _ --- Date ---------------- ------ -- ----------- Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT F H- 9 1-'68 Rev. 5M _