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FOR OFFICE USE: �.TM... ---------- -------------------- a F.�, -• �� APPLICATION FOR SANITATION PERMIT I---------- (Complete in Triplicate) ------------- _ ------------ Permit No. --------------------------------- ----------- ---- - -- --- - ---- This Permit Expires I Year From Date issued Date Issued Application is hereby made to the-5an`Joaquin Local Health District for a Permit to construct and install the work herein described-This application is made,in compliance with County Ordinance No. 549 and existing JOB ADDRESS/LOCATION Rules and Regulations: --------------------------------------- ------------------------- -- --- Owner's Name -_ -------_--- 7 � f CENSUS TRACT ___ � Address rr Z ---------------- ------------- ---------- - -�!-_.C{ on c� � - �./� Contractor's Name r�'-�v_ CitY•-'� f = � Installation will serve: ------------------------ -----License # Residence ------------- Phone '(Apartment House,❑ Commercial ❑Trailer Court ❑ 0V Motel ❑Other ----------------------------------- Number of living units:---/_-. Number of bedrooms __ -� Water Su 1 Size f c� -____.Garba a Grinder -------__--_S Lot Size --__-_-- - _ pp Y: Public System and name ----------------------- 14�d �' _ _ s /--- Characteeof soil to a depth of 3 feet: Sand"[] Sift❑ Cla - - - - Private,® Hardpan Y ❑ Peat❑ Sandy Loam ❑ Clay Loam p ❑ Adobe E]- Fill Material ------------" �f Yes, type ---- ______ _ Plot plan, showing size of lot, location of syste n relation to welts, buildings,;.etc. m _.: NEW INSTALLATION.- r -. (No septic tank or see ge pit permitted if public sewer is availableswithin p20D eet on reverse side.) PACKAGE TREATMENT f 7 SEPTIC TANK ft �`� Size�- _ --- _ �C` [� , - Capacity Id d - ----- Liquid Depth`�� --- ` ---- Type- Material _ J (stance to nearest: Well (. J /7J� NO' Co' _ -� • LEACHING LINE Foundation ��.. No. of Lines ----------- Prop. Line __U_,_-_-,_.•_.___ ---- ---- ------------- Length�ach ine -��f - � 'D' Box ___ T �� --- ------ Total Leng�ca�_2_ Type Filter Materia! _ _____________Depth Filter Material ----------- Distance to nearest: Weft ._ r l / •=---.---_--• a SEEPAGE PiT � ------ Foundation _ _-- 1 ] Depth ' - -------- Property Line �a_-____--- ------------------- Diameter ---------------- Number ------------------- 0 Water Table Depth __-___--------------------------------------- --------------------- Rock Filled Yes ❑ . No i❑ 's --Rock Size -------------------------------- N -------------------- D(stance to nearest: Wel! ......................... ----- -- -- 9' Foundation -- Prop. Line ---- REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------- Date ) Septic Tank (Specify Requirements) -`-------•----- - Disposal Field (Speci-fy Requirements) - - - o ------------ ----------- --------------------------------------------- v (Draw existing,and required addition on reverse-side) . I hereby certify that I have prepared this application and that the work will be do -4 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home ow done in accordance with San Joaquin i sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ an owner or licen. as to become subject to Workman' Compensation laws of California.- Signed Y y person in such manner Signed ---------- -- ------- t ----------------- Owner PD (if other than owner) ------- ------- -Title ..---------------------- ------------ FOR DEPA1tTMENT USE ONLY T` APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED -----.-_- - ---------------- --------------- - COMMENTS --- r DATE ._.._ ---------- DATE ----------- ,. -- - ------- ---- - ---------•---------- -------- --------------------------- ----------------- (nal lnspec ` 'L %� - _ ----- --- --- ----- --Date ----- p SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M