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f FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �aS Permit Na. _._��-------- =----- ---------------------- .. .. - - . - - -•;Complete in Triplicate) • _ •-�-�--•-- � - ._ 4 --- ----�-- ---- ----- ------------------------------ � Date Issued ------------------- 1 "-_- This Permit Expires 1'Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and .install•1the -work herein ' described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 4 JOB ;ADDRESS/LOCATION .----- - �-----3�------- -- ----- ---------- - -------------------- -- -------- ---- -- - -- CENSUS TRACT --------------- ----------- �- Owner's Name ---- -- --- - `------- ------------------ ------------ --------- --�---------- -- -- Phone 3- - - -�' c = ✓-C- -- ------------------------------------------------- Address . ___ - __ --------. City i13 -----.License #i2_ f-_7 Phone Contractor's Name X�_ -Installation will serve: esidence ❑ Apartment House,P Commercial :❑T'railer Court i❑ Motel ❑Other __P + ev Number of bedrooms ----_-- _Garbage Grinder _--- Lot Size - --- -- --- ---- - ------- Number of living units:._-_.-_---. ` Water Supply: Public System and name ------------------------ - ------------ --------------------------------•------- -------------------- _--Private' Character of soil to a depth of.3 feet: Sand'[] Silt-El Clay ❑ Peat❑ ., Sandy Loam ❑ ,Clay Loam E] l t 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.) (,d NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ty PACKAGE TREATMENT 91 :SEPTIC TANK:( I Size.--- -- --�---— Liquid Depth --- ---•------,----- C+� j - No. Compartments�- Capacity -!_��.7--�---- TYPe -�--- - Materia! � - - P ------•----•---•-----• - ---- -----=---- - Distance to nearest: Well _-- �-----------------------Foundation ----- ----------- Prop. Line __-._ --_--.----- tline p LEACHING'.LENE [d No. of Lines-...-____�--------------- Length of each line----.--,%0��' Total Length ------------------I-� - ---I-lam -_" /11--- [� Type Fi1te�Mdtena! --------------------Depth Filter Material .---"---+-- V - pi°stance-•to-nearest: Well .- -------- Foundation _-__--.-/-V___'��_.-Proper-ty_Line___��-__---- -�. SEEPAGE PIT �(j Depth y'r Diameter -------- Number --------------------- --""-- Rock Filled Yes l�j No 0 /q 4 Water Table Depth (/ ---------------------------------Rock Size -------------- ii� Distance to nearest: Well ___- 1 ------------• Foundation _�-d - ----- Prop. Line " --~---•-.------ i REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- -- Date ---------------------------•------1 Septic Tank (Specify Req'uirenentsl ------------- ---- - - ----------------------------- Disposal Field (Specify .Requirements) ------------ ------------------------------------------ -------------------- -----=------------------------ ------------ --------------- --------------------------------------------------=----------- - (Draw existing and required addition on reverse s� el . 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, 1 shall not'employ any person. in such manner as to become subject to Workman's Compensation laws of California." Signed - ---------------------- _ = -------- Owner_,-..-,..� ....y " Title ------------- ---- (If other than Ohner) -FOR DEPARTMENT-USE.ONLY-. - APPLICATION ACCEPTED BY ---- ------------------------------------ --- DATE -Al --7-3�------------------ --- - - ----- ------------------ BUILDING PERMIT ISSUED _-. DATE ---------- ------ ADDITIONAL CO MENTS �` "� �r- ------------------------------------------ ---- --------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------- ----------"-- -------------------------------------- ----- --- ---------- ------------------------------------------------------------------------ Final Inspection b ---------------Date ---- -- - l -3----- ---- ---- - ---- - ------- - ------------------------------------------------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT - I E. H. 9 1-'68 Rev. 5M