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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a ------------------------------ Permit No. -9_�-=-d-6 (Complete in Triplicate) ---------------------------- Date Issued ___�_ 3 ---------------------------------------------- This Permit Expires 4 Year From Date Issued Application is hereby made to the San Joaquin Local Health,District for a permit to construct and install the work herein described. This application is made in compliance with County Or inance No. 549 and existing Rules and Regulations: r JOB ADDRESS/LOC N ----- ------ CENSUS TRACT -----------------='------- Owner's Name -------- --- ---- ------- ------ -- --- --- ---------------------------------------------- phone ------------------------------------ El -----;---- --- Address - Cit e------------------------------------------- -- Contractor's Name ---------- ---- ----- - ------------ ------ - ----------------License # 18 _3 Phone --------------------•---_-•-- Installation will serve: Residence n partment House, Com rcial :❑Trailer Court '',❑ Motel ❑ Other --------------------------------------- Number _ ---------Number of living units:----- _____ Number of bedrooms --- ------Garbage Grinder ------------ Lot Size ------____ -�Pr_;12---------- Water Supply Public System and name -------------------------------------------------------------------------------------------:-------- Y--- ._Private Lam" Character of soil to a depth of 3 feet: Sand❑ ❑Silt Clay El Peat El Sandy Loam]—_Clay"Loam Hardpan ❑ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or p ' seepage pit permitted if public sewer is available within 200 feet,) � iPACKAGE TREATMENT { ] SEPTIC TANK'[] Size____ �-_____�__�____X___.-r_----.-- Liquid Depth:_______ _.__.____.___.____.� Capacity1�0d q Type �___�_�afierial____�L N Compartments ____c ..�...__.__W J V� i t Distance to nearest: Wel! ----------_�" � ------------Foundation --------- ----- Prop. Line --------- LEACHING ___sLEACHING LINE [P� No. of Lines --------f------------- Length of each line--------l.1PsQ ___ Total Length ---J.0_4.�---_---:- 'D' Box .___ Type Filter Material .........c5._)C____Depth Filter Material ____ _''___________________--_____:__._ f f. Distance to nearest: Well -------St'---------- Foundation -------C_b----------- Property Line ------47-------------- Z` SEEPAGE PIT �[ff Depth -----2_.a------ Diameter Number -----------4t------------ Rock Filled Yes [Tr No .1❑ ` t .. �. Table Depths /------------------- WaterRock Size ' Distance to nearest: Well -----------Ion____________________Foundation -4-0----------- Prop. Line ----5____..---------- eQ REPAIRJADDITION(Prev. Sanitation Permit# ----------------------------------------- -- Date _____-.-___-_________ ----------) C ISeptic Tank (Specify Requirements) -------------------------------------------------------------------------------------------- -----------------tj•--------------------------- Disposal Field (Specify Requirements) -------------------------------•-------------------------------------------------------------------------------------•--------------- ------------------- ---- --------------- ----------------------------------------------------------- -------------- ----------------- -- ---------------------------------------------------------------------------------------------- (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: "1 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 ------------- ----------------------------- ------- ------------ . Owner By -- ----------------------------- ------------ ----- 4 Title ---------- - ----- ------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -----------------------, DATE ---- _______-----. fBUILDING PERMIT ISSUED -----------------------------------------------------------------• -------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS -- -------------------------------------- -----------------------------------------------------:------------------------------------------------ -------------- ) ----------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- _ Datef 7 -- ----------- ------------------- Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.