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3 FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT --------------- --------------- - - -- - - --• - (Complete in TriPermit No:plicate) y ----- -------------------------- _______---- This Permit Expires 1 Year From Date Issued �+a _ Date Issued Application is hereby made to the San Joaquin,Local;Health„D.istrict for a permit to construct and install the work herein described. This application is.made in cam _Ordinance No..5.49 and existing Rules and Regulations: JOB ADDRESS/LOC: ``ATION ,- f--------------- -- ------- ---a--- ___& --------------------------------- CENSUS TRACT ----------------- -------- - Name _._<l.- �-j�L -�l 1 Phone -- ------- City - i`J` ------ -- ------ ----------------------- AddressContractor's Name _--- _--------------------------------------License # ,/ 1.4hone�� Installation will serve: a Residence partment House-[] Commercial ❑Trailer Court ;❑ Motel ❑ Other ------------------ ----- Number of living units:__. Number ofbooms ----_"_ re GrinderN -_-. Lot Size � 1 ------------ ---------------------------------- __- r Water Supply: Public System and name � ---r- ------ Private ❑ Character of soil to a depth of'3 feet: Sand'❑ Silt❑ Clay Peat❑ Sandy Loam -❑ Clay Loam:D i, Hardpan E] Adobe Fill Material/P/19___ If yes, type ____________________________ t , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No soptic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK Size---- �2�-------- Liquid Depth - ��--,----- . a � Capacity __� - Type _L!IA .f Material2_ No. Compartments -------- _____________ �9 Distance to nearest: Well ____`” '_________________Foundation __/o__-_______ Prop. Line _ __._______.. LEACHING LINE No, of Lines -----I----------------- Length 1 e ch line.... k_i9_�_____.._____ Total Length JA----j__-_--______-- F 9 , b' Box,)1J---- Type Filter Material i?_lz� - Depth Filter Material �_�__.-_________------------------------ /6 _______________________ r Distarice-�to nearest: Well ---- __1-- Foundation __ �-------`---.--_ Property Line �? ------------•--- SEEPAGE PITS''' �!.`, r Depth _ -�________ Diameterr�_____ Number` __________ ______ �_______ Rock Filled Yes jp_ o 0 Water Table Depth --------�----------- ----------•--- ---.Rock Size -� --�=`------------------- or --Foundation p. Line --Is Distance-to nearest: Well ----------�------------• ---------v---•---- Pro -------------•- REPAIR/ADDITION(Prev. Sanitdtion Permit# ---------------------------x---- - Date ----------------------------------} Septic Tank (Specify Requirements) ----------------------------------------------------•---------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- . t --------------------------------------------= '---------------------------------------------------------------------------------------------------------------- - -------- ---- - (Draw existing and required addition on reverse side) I hereby certify ih6f I have prepared this application and that the warklwill-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 "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 subject to Workman's�Compensation laws of California." Signed -------------------------- ----- -------------------------- Owner By ---------------------------- . _. Title 4- (If other th o "r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------=------------------- DATE --- --------------------------------------- BUILDING PERMIT ISSUED --------------------------- ------------...... -----------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------.-- ` =-------------------------------------------------------------------------------------------------------•---------------- w ----------- --- - - --------- -------------------------- ------------- i ' -__-___--- - ----------------- ------------------------------- ----------------- -------------------------- -- --------=•------ ------------------------------- - ----------------- FinalInspection by: - - --------- ----L = • ------ --- ------------------.... '--------------------- -------.Dote ----—------------------------ SAN J IN LOCAL HEALTH DISTRICT W M E. H. 9 1-'68 Rev. 5M