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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- -------------- -- ------------------ - (Complete in Triplicate) Permit No: ------ ----------------------------------------- ---------- ' This Permit Expires 1 Year From Date Issued Date Issued Application is hereby mcide to the San Joaquin Local:.Health District for a permit to construct and install the work herein described. This application is made in,complionce:wiih County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO TION/A/10SI -- ------------------ - 'r.,---- -- ----------------CENSUS ' C't T RACT -------------- ----------- Owner's ----------Owner s Name - Phoe - -Address . - -' - _..... P f Contractor's Name ----------- - :License # Phone -------------------- - - a Installation will serve: Residence ❑Apartment House❑Commercial :❑Trailer Court Motel-❑ Other ------ ---------------------------------- Number ---- Number of living units:.___---_____ Number of bedrooms ---.-_---Garbage Grindor _.------------ Lot Size __________________________ ------- Water Supply:`Public System and name _____________________ ---------I- Private •------------------ == - Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam f } Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- Ilk (Phot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) to NEW INSTALLATION: (No septic tank or seepage pit permittedif public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK ] Size--_--____ __ "- �--------- ---------- Liquid Depth _______.._._..__._.._. �! Capacity V6 0-...--...... Type -------- ---..._Material_ _-_.__ No. Compartments ------•-------------•- `; Distance to nearest: Well --------- ---------------Foundation ---lP--`_________ Prop. Line __-ter'______________ . _ LEACHING LINE t -Na:1of lines ` Leri° th of each line____;�_m g [ -----,-/.----- g Total Length __� 'D' Boer"—___. T'#e Filter Material -__S�-_ _--_Depth�Filter Material __��_-��---::___,_ _ _ _. Distance.to nearest:. Wel.1 -- ----- Foundation __..1�-------------- Property Line i-�__.__.-__------_ SEEPAGE PIT I I Depth - �- ,.'t'-- Diameter ------------ Numberi_--_-__-___-________________ Rock Filled Yes ❑ No 0 --� — � J, S , Water Table Depth -----------`--F f.._ Rock:Size" ' = �t F REP lR �� F t =-------------- -`-------Foundation�_i?.`------ ---- Prop. Line ---------------------- Distance to nearest: Well _____________ r A /ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------------- SL ) i ptic Tank (Specify Requirements) ----------------------------`----------------- `--------------------------- -- . Disposal'Field (Specify Requirements) --__-_"'__-_-- _ k -------------•----------------------------------------- ----------------------------_ _----------------------- - --------------------- ------------------------------------------------------ ------------------------ f ----------------------1- -- ------------------------------ ___--_--_-.---_--_._____ _ -__--_-------_>-------------------------------------------- ' (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." i Signed -=----- -------------- -------- -------- Z ------------------ Owner r BY = ' -lig-ts� Title --- (If other than owner) 4 FOR DEPARTMENT USE ONLY APPLICATION )ACCEPTED BY ------------------- BUILDING PERMIT ISSUED ------------------ -- -----------------------------------_-.------------------------ --------------DATE ADDITIONAL, COMMENTS - --------------- ---------------------------- ----------------------------------------------------------------------------------------------- --------------- ----- --------------------- -------------------------------------------------------------------------------------------------------------------------------------- ------ - ________________________________.._ ---------------- ------------------------------ _ ____ .-_-__-_---________ _ ________ ______----__ f _ p Y Final Inspection b �' SAN JOAQUIN LOCAL HEALTH DISTRICT � ------------------------------------•------------------- -------------- -Date -ir---- E. H. 9 1-'68 Rev. 5M, s