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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ".,v- -------- ----------- (Complete in Triplicate) �� (p/�� _________ __ ------------ Date Issued ------------ ------- ---------------------------- This Permit Expires 1 Year From Date Issued uct and install the work herein Application is hereby made to the San Joaquin Local Health District for a per to constr described. This application is made+ in compliance with County Ordinance No. 549 and existing Rules and RSulations. 7 �fll�/S �Or9� CENSUS TRACT ---------- = JOB ADDRESS/LOCATION _____________ __ 7 _---""phone - - f Owner's Name -"----- --- - - Cit --- ------------------------------------------------ '•------ Address -------------------- - - --- ------------------- Y -----------.License # ---__ :------ ----- Phone -----------------------•------ .S}} _ -------------- . Contractor's Name ------------------- - �---- ------ -- -- - - - , Installation will serve: Residence%Apartment House❑ Commercial❑Trailer Court ❑ ; Motel ❑ Other ------------------------------------------- � i4G.2 S Number of.,living units------ "____ Number of bedrooms _____ ___-__Garbage Grinder ------------ Lot Size ______--___--------•------- _ ` Privat Water Supply: Public System and name:_______.-_r-==------------- - T ------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑.o-: Sandy Loam.❑ Clay Loam '.E] .- ;Hardpan ❑ Adobe ❑ Fill Material ------------ if yes, type --------------- > -- T buildings, etc. rimust be placed on reverse side.) `t\ (Plot plan, showing size of lot, location of system in relation `to/welds, _ .. NEW INSTALLATION- (No septic tank or seepage pit permitted 4f-.p�blic sewer is available within 200.feet,) SEPTIC TANK -------------------- Liquid Depth = ` . PACKAGE TREATMENT ( ] I V V J _ Ca acit Type Material---------------------- No., Compartments ,------------ py ------------ - Distance to nearest: Well __"-_""-- ==----\ 1=--- -Foundation---------'----------- Prop. Line----------------........ �i CAST/� , ' ------- ----- Length of each line------ Total Length ----------------------- LEACHING LINE [1c1 No. of Lines "_ ..__ -" „�e S < 1L /i � _ 'D' Box -�4N_,Type Filter Material epth Filter Material _"" Distance to�near t: e11 _� ----- Foundati n -.---.�`_--f---- Property Line - -•-----=-• �. SL4M r i_ " Rock Filled Yes No d] et --- Numbers-�. ----- r,t; STT L l Depth '7`- X Di��ter 1 4 t� - �-- -'2� i Water Table Depth f ___-_____.Rock�Size / ---------------- /---- --------- l* Z �� Foundation t - Prop. Line •f------- Distance to nearest. Well _--- • -------------------------------------------- Date - -----------------------------=--).. REPAIR/ADDITION(Prev. Sanitation Permit}�# -------- ---- Septic Tank (Specify Requirements) ----------------------- ------------------------- -- � 4., Dis osal Field (Specify Requirements) --- ----- ^ ,r ------------- -------- ---- - - - - - ----------- ------ - - --- ------ ---- -- - --------------------•---- - (Draw existing and required addition on reverse si d e) I hereby certify that 1 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed 17-7' -------------------------------------- Owner --------------------------- -- - ---- --------------------------------------- ---------- Tit e ---------------------------------- - ------------------------- - (if other than owner) FOR DEPA-RTMENT USE ONLY /7 APPLICATION ACCEPTED BY �- ---- _ - DATE ----- -----------'7 - DATE BUILDING PERMIT ISSUED ---------------------------------------------------- ---- ----- - ADDITIONAL COMMENTS ---------------------- ---------------- ---- -------------------------------------------------------- ------- ---- - - ----- --- _ - Date __. j- - __ _ _ . _ _ _ __ / - Final Inspection by: - - - " " - -- ---- --- --- ---- ------- SAN JO UIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M