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FOR OFFICE USE: h.------- APPLICATION FOR SANITATION' PERMIT ; APPLICATION Permit No: (Complete in Triplicate) 3 ----------I----------------------------------------------- I Date Issued _- :I This Permit Expires 1 Year From Date Issued q I 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 Ordinance No. 549 and existing Rules and Regulations: M JOB ADDRESS/LOCAT ON -_/' r - ' �.Q (�!ks -Izc: - --- ::: . . --CENSUS TRACT -------------------------- Owner's Name -- -- --- � Phone �[ -. Cit -- ------ (cam ' f -.License #�� 4P hone Name Installation will serve. - Residence L-j"'0Apartmerit,H6use,❑ Commercial ❑Trailer Court ,❑ Motel ❑ Other ----- -------------------------------------- urriber of living units:------ .---- Number of bedrooms _� N ''_-__Garbage Grinder ---.-_f_r_ ,Lot Size _1-0/��---------------------- Water Supply: Public System and name ----------------------------------' '= '-------------------------- ----------------------Private Er ,I Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ , Clay:Loam :179 Hardpan ❑ Adobe'❑ x Fill Material------------- If yes, type -------------_------------_ (PI'ot plan, showing size of lot,11 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 14-1,SEPTIC TANK [ ] � >/A X I® f x's-------------- Liquid Depth 4'-------- \ p :i tSIZe '----------------- '-------- �a Capacity -J�oo---- Type+ �!--- Material�"�'�-�__ No. Compartments �----_-i------ Distance _-_-_.... n it t nearest: Well s___ -- ._--- I,-:_-_____--Foundation _._f fJ�___------- Prop. Line _-- -------- - Dista ce o ------ II i !' V / 4 LEACHING LINE I&K No. of Lines --------$------_---- Length of each line------�`'------------- -- Total Length :--------------------------- \ , r- 'D' Boxy------------ Type Filter, --------------------Depth Fitter Material ----- --- ---- --•- - Distance to nearest: Well ------------------ Foundation -----.------------------ Property Line. ------------ ----------- SEEPAGE PIT' [ ] Depth 11------------------ Diameter -------------- Number ---------------------------- Rock Filled ,Yes C] No 0 ..Water Table `I:}epth '-- -------------------------j------Rock Sizer '--=--------------------- s Dista - Foundation -------------------- Prop. Line- ------- -------------e to nearest: Well ---------- -------------_-_:--- - REPAIR/ADDITION (� (Prev. Sanitation Permit r# --------------------------------------------- Date _-_--_--------------_-_-----------) i Septic Tank (Specify Requirements) ------------------- = -_ _ .,. - --------------------- Disposal Field..(Specify;,Requ„irements) _ ------------------------------ -------------------------------------------------- I - ---------------------------••- -------------------- ------ - r (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.b o subiect to Workman's Compensation laws of California.” i Signed, -- ------- ---------- Owner ----------------- Title --- n (If other than ower) -t s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ---------- DATE J 'S�' -. --------------- BUILDINGPERMIT ISSUED -------'i--------------------------------------------------------------- ---------------- -----------DATE --------------------------------I---------- ADDITIONALCOMMENTS ----------- --------------------------------------- ----------- ------------- --------------------------------------=-------- •-- ---- ---- - ----------------------------------------------- �i------------- ------------------------ -------------------------------------------------- ----------- --------------------- --------------- ------------M_'__----------- - ,i ' Date . Final Inspection by: - --- -- - -- - -�' - - ---------------------------- --------------------- ---------.- ------- -- - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M