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FOR OFFICE"USE: APPLICATION FOR SANITATION PERMIT Permit No. - -� -` ---- ---------- (Complete in Triplicate) 1. Date Issued - --------------------------- This Permit Expires 1 Year From Date Issued Local Health District e work herein Application is hereby made to adSoin compliance with County Ordinance oinstall lh the 549 permit d existing g RulesandRegulat ons.. described. This applicationi i JOB ADDRESS/LOCATION �t�� >�D_ -CENSUS TRACT -------------------------- Phone ` Owner's Name __ � - -T--S L 1L Llk�- ---------- -V- _ ll= !/, -`---------------------•• City _.� � Address _. 6 �� --- --- �f -/ f. Name _ -------S_ �`------- - --------License # Phone /�. � Contractor' _.�� --c��`'�--��- -- t i Installation will serve: Residence Apartment House Commercial`:❑Trailer Court ,❑ Motel ❑ Other ----------------------- -------------------- Number of living units:----[------- Number of bedrooms ---J----Garbage Grinder WO Lot Size l F-1 - ---•--------•-_---Private Water Supply: Public System and name ------------ ------ ----------------------- ---- y t Clay Peat Sand Loam ❑ Clay Loam 0 y Character of soil to a depth of 3 feet: Sand❑ Silt❑ Y ❑ y Hardpan ❑ Adobe-{N� 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.) W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK' Size r.2� _,v_.� ------------ Liquid Depth __S` f -----• 6, PACKAGE TREATMENT [ ] _ ri / Compartments ----------- Capacity 1 i =-•-• iO ----Foundation - __1 Pr---------- Prop. Line __ .�---=-------- Distance to nearest: Wel! ____�---------------•----- - Len th of each line.___---------------- Total Length �-1� - ------------ LEACHING LINE; ,[q: No. of Lines _-_ ----.-•--- -- g D' Box . �' - Type Filter Material �-----�- ----Depth Filter Material -.-1 -------- - Distance to nearest: Well -----�5`=��------ -----_ Foundation ...._fid------------- Property Line SEEPAGE PIT [ ] Depth Diameter------- --- Number ---------------------------- Rock Filled Yes E] No 0 --------------- Water Table Depth -------------------------------------- --------Rock Size ~ ---- -Foundation ------ -------- ---- Prop. Line -------------•------ Distance to nearest: Well _____._________________________ _ � REPAIR/ADDITION(Prev, Sanitation Permit# ------------------------------------------------------------------------ Date ------------------- --------------) Septic Tank (Specify Requirements) ------------------------------- ------- ------------------ ---------------------------------- ----�---------- Disposal Field (Specify Requirements) -------------------------------------------------------------- ----------------- j - ---------------- --------------------------- ------------------------------------------- {Draw existing and required addition on reverse side) I hereby certify that I have rplapplicationRegulations that the work will be done in ic , It County Ordinances, State aws and Rues andof the San Joaquin Local Health District. Hoe owner or en- sed agents signature certifies the following: r "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 ..------ { other than owner) - rw- FOR DEPARTMENT USE ONLY DATE --`-- -- --� APPLICATION ACCEPTED BY ___- ----------------- ----------------------- BUILDING PERMIT ISSUED -------------------- ---------- --------------------- ---------------------------------DATE -- - - - - ----- -- - • --- ADDITIONALCOMMENTS ---------- ------------------------- ------------------------- --------------------------------------------- - ---------------- --------------------------------------------------------------------------------------------------- -� ----------------------------------------------------------------- -------- z- ��7 U-------------- - _ Date Final Inspection by: _._ -=----- ------------------ i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.