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FOR OFFICE USE: tA � � 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 San Joaquin Local Health District for a ' described. This application is made in compliance with County ordinance Nomi4toanonstX st ng Rulesuct andtandthe work h Regulatonsrein l/Y55 ` JOB ADDRESS/LOCATI _. -- - r---------- --- ----- - ------------ - i + �NSUS TRACT Name _ ------------------- on AddressQ Ph e ---------------- ------ --------------- Contractor's - --- ----- - - ---------- --- Cit 461 --- -- ----- - i Contractor's Name -------_ -"-- -------------------------------- - - -----•-------•-----•-- ------------------- ---------------License # _ i Installation will serve. 1�--- Phone " Residence�Apartment House❑ Commercial : Trailer Court kMotel ❑Other -------------- "" Number of living units:_____ -__ Number of bedrooms ___Garbage Grinder ------------ Lot Size ---�� L Water Supply: Public System and name ---- "________ I ------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ . Clay Loam Ej Hardpan [] Adobe ❑ Fill ,Material if estype Ype ---------------------------- (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,PACKAGE TREATMENT SEPTIC TANKizeCapacity ---- -- -------- -------- --- Liquid Depth _y_. ->-,- ------------- Type r ' _ _____ Material__ ,, --- No. Compartments Distance to nearest. Wel! -------- ------------ --------- Foundation 1O-!.} LEACHING LINE " Prop. Line _ No, of Lines _ �-'� ''"r � Length of each line:_;_. + " - -.-�---- Total Length _.!_�__�----- , `D' Box ____Type Filter Material -----Depth Filter Material ______ `� .—..._...__Distance.to.nearest; Well.-----..��_i,-_" 1 ----------------- -- ----------- ------ t ___ Foundation:___.__ __ P � l SEEPAGE PIT Depth Property Line __ _ : Depth ------ Diameter ---------------- Number Water Table Depth ------------ -------------- ------------- Rock Filled Yes 0 No u ---__.___--Rock Size - -- Distance to nearest: Well -----------------------------------------Foundation _-_--_-------_.:Prop. Line ------•-----......._REPAIR/ADDITION(Prev. Sanitation Permit# _________________"___-____ __ 1 4_. ' -------------------------------------- Date Septic Tank (Specify Requirements) ---_____.._" x ' ------,------------- - ----- ---------- ---------- ------- - -. .3, _ „Dis osal Field (Specify Requirements) ---------- -------- ------- -------"'"--"-"--------'-- . ----------------------------------- Ft ________ --y :--_------------ `- ---- i (Draw existing and required addition on reverse side)'` `" 1 hereby certify that I have prepared this application and that the work will be doin accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joane quin'Locral 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 an � as to become subject to Workman's Compensation laws of California," p y Y person in such manner Signed ------------- Owner-- f - - -.= r Owner BY - -- --- ----- lv - ------ Title - (if other a owner) F ' FO DEP TMENT USE ONLY APPLICATION ACCEPTED BY --- JA __ - BUILDING PERMIT ISSUED -------�` -------- ..T� r,� TM --- ---=--------------------- DATE .mfr --- - - -------------- ADDITIONAL COMMENTS ------------- --------- ------------- - -------DATE ---- _ -------------------------- - ---- - - ------ •---• ----------------- ---- -- ------- - --------------= :Ii , --------------- ----------------- =Final Ij5qcton �r ------- " Date -------------------------- T _SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. r r