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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - � ,, Permit No: -- __7.��-__----- ------ --------------------------------- ---------------- (Complete in Triplicate) ------------------------- ---------------- Date Issued P _- _____�--------_--•- ---------------------------------------------- This Permit Expires 1 Year From Datb Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein �p p with County Ordinance No. 549 and xisting Rul s a d R ula#ions: described. 3s a lica ion is made m compliance w a G�� RACT _ 619 CENS ------------------------- JOB ADDRESS/LOCATION -- mss- `s- T��_ _2 r--------------------------------------------- --------- --- .-Phone _-D•�� d - - Owner's Name - -----------�-'---- Address --- cam- �j ------ F---- T ----------------- ------------ City/ -�7 " / nn --.License --- --� 7/------ Phone Con#ractor's Name - �--�- -•--- ��------�f---`--�----- --------- ------•--- - t - -- installation will serve: Residence ❑ Apartment House-M Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units ------ Number of bedrooms _3------Garbage Grinder ------------ Lot Size -------------------------------------------- I - Private,®' Water Supply: Public System and name ----------------------•--------------------------------------------------------------------------------------- Character of soil to a depth of 3 feet: SancI N Silt❑ Clay ❑ Peat❑ Sandy Loam .F� Clay Loam-C3 i Hardpan ❑ Adobe ❑ Fill Material ------------ if yes,type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK' Size-----------� -� _�' Liquid Depth -----•, PACKAGE TREATMENT [ ] [ l ypQl-- o.0 ompartments --- .�------... � . Capacity / - ------ T e Material (� r f; Distance to nearest: Well ___- ---:- Foundation a Prop. Line --- i LEACHING LINE [ ] No. of Lines -- -------------- Length of each line--_-- --C3 Total L ! � a W F . D' Box .___�__ -- Type Filter Material ________________---Depth Filter Material __ _______---- -- ------------------------ +lh Distance to nearest: Well __4 ----.-- Foundafiion 1 Q / --- Property Line �---------No ---- , t Depth --------- Diameter ---------------- Number --------- ------------------ Rock Filled Yes ❑ Co t SEEPAGE PIT [ ] P --- ----- O Water Table Depth ------------------------------------------------Rock Size ---- Distance to nearest: Well ----------------------------------------Foundation ------ --- --------- Prop.:Line -- ----------------- Date ----------------------------------) si REPAIR/ADDITION(Prev. Sanitation Permit# -..----------------------------------------- Septic Tank (Specify Requirements) -------------- ----- - -------- ------------------•----'------- - ----------•-------, Disposal Field (Specify Requirements) ______-__-_ ---------------------------------------------- - --------------------- ----•--------------- --------- - ----------------------------------------------------------------- - ------------------ ----- ------------------------------------------------------------------------------------------------------ ------------- ---------------- (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 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Owner ` _ Title ----- ---- ----- ------------------ y ----------- ----------- (If other than owner) QIb DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ---- DATE ------�---7------- `5 --------- - -------- --------=-------DATE -- ---------------------------------------- BUILDING PERMIT ISSUED ------------------------- - ---------------------_ - iADDITIONAL COMMENTS ------------------------------- --------:---•-- ---------------------- ----- - . --------, ---- ---------------- ------------------------------------------- ------------------------ ------------------ --- ---------------------------------------------- = ----- -- ---------- - --------------- --------------- " ----------------------- ----- Date ----y- ? --- Final Inspection b -------------------- -------------------- ----- ---- -------------- SAN ------- ----SAN JOAQUIN 'LOCAL HEALTH DISTRICT : E. H. 9 1-'68 Rev. 5M