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FOR OFFICE USE: APPLICATION MR-SANITATION PERMIT _ Y -------- ---- ------- -_-___.___.--- .r' Permit No. _-7-__�-----_-._-- (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued /Z-?-.- ------------------------------------------------------ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a pli a�15 made in compliance with County Ordinance No. 549 and existing Rules and-Regulations: JOB ADDRESS/ OCATION . -- - --- ® =- II'��/ 1> ld� _-CEI�SGTS RAC Owner's Name - -L �� - P-----=---------------------Phone G ., , � Address - -------------- Off`.. ... ! City - ----------------------=------ ---- ----------- Contractor's Name - 4P�`��------------------------------------- - --- -License#o'f: �. x = Phone = r Installation will serve: ResidenceX Apartment House,[] Commercial :nTrailer,Court ',❑ Motel ❑Other __ ----- - ---- J i Number of living units:---,/*---- Number of.bddro"oms _-,I--_- Garbage Grinder�A1- Lot Size I'M�-•��-------- -Garbo - -- Water Supply: Public System and•name x��_/ _f _1tA -------d '_ --------------------•------------------- Private ❑ Character of soil to a depth of+3 feet: Sand Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam E] Hardpan ( ' Adobe —Fill-Material --`-elf-yes ype- - (Plota 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 pyblic sewer is availablewithin 200 feet,) / a PACKAGE TREATMENT [ ] SEPTIC TANK' SV_;_P Liquid Depth 'j_i.- ------- --- Capacity/Ze�,-- Type__ aterial-_0<(y17Z' No. Compartments __�___•. .__. Distance to nearest: Well --- '---__ __--_-_---_- Foundation _,f �_---_ Prop. Line ___ .--------- LEACHING LINE [V No. of Lines ----------- Length of each line ---e- _-.--_I__.___--- Total Length /-�zw............. �De th Filter-Materials'^_ !*-_-°10---------------- ---- ' I 'D' Box r�- Type Filter Material/ p ` Distan to nearest: Well ---!.. ---------- Foundation _ - -------- Property Line. V.:.....:........ SEEPAGE PIT [ ] Depth ,,� �_--___ Diameter'7h'_- -- Number ----- ________________ Rock Filled Yes No i❑ °�: Ilk Water Table Depth -----��-1--------------------•--------Rock Size _ � ---------- . Distance to nearest: Well -------_`"�--=�)--------------------Foundation _--!_____ Prop+=Line .. - REPAIR/ADDITION{Prev. Sanitation Permit# --------------------------- --------------- Date ---------- ------------------- z' Septic Tank (Specify Requirements) -------------_>-=---------_•___-._..---------------------------------------------------.------- --------W.:-----------------•---------- Disposal Field (Specify Requirements) ------t----------------------------------------------- ----------------------------------------------------------- ------------------ ---------------------- i ----------------------- ---------------------------------- --------------<---------------------------------I------- ----------------------------------------------------- (Draw existing and required'ciddition 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-owrl& or,licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit1s. issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." t Signed ----------------- ---- ---------- -------------------------------------- Owner f --- Title } `�" BY _ f (If er than owner] FOF,,PEP6tTMENT USE ONLY 4 APPLICATION ACCEPTED BY ----------- ------------ BUILDING PERMIT ISSUED ------- ---- --- " ----------- ------------------------ - --------------------- - -----------DATE ---------------------•------------------ -- ADDITIONAL COMMENTS ----------------------------- - --------------- --------- ----------------- -------------------------------------------•------------------------•- ------------------------ s D --� -- -- - ------- - Final Inspection by ----------- - --- ------- =------------------- ate / t l SAN JOAQUIN LA-6L. HEALTH'DISTRICT E. H. 9 1-'68 Rev. 5M