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Foa OFFICE USE: APPLICATION FOR SANITATION PERMIT S-�Lai ------------- - -- -- --------•--------------------- Permit No.. (Complete . •- - � � (Complete in Triplicate) --------- +t Date Issued --------------------- ----------------_-_----_------_-- This Perrmit Expires 1 Year From Date Issued � r 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: . 1 F 1 1 j JOB ADDRESS/LOCATION ---------------------------------Z)AeS __OV IF,GS � ' � ---------CENSUS TRACT ----------------_-------- _. � �--. -------Phone Owner's Name ..... - ---------------- . _ Address -- --------- -46wwO ° - ---•----------------s- city '---------------------------------- �/ � �, .- f'_.License Phone Contractor's Name ------ -- - • ��-- ------------------------------------- --- -- �. I installation will serve: Residence ❑ Apartment House'❑ Commercial ❑Trailer Court '❑ Motel ❑Other ---- nits:---/------ Number of living units:___f____ Number of bed rooms4______Garbage Grinder _.______--._ Lot Size _. ��- Water Supply: Public System and name -------------- `----------------------------- ------------------- •------ ---------------Private Character of soil to a depth of 3 feet: Sand'❑,re Silt❑ Clay ❑ f.Peat❑ Sandy Loam ❑. Clay Loam- Hardpan .' Adobe Cl Fill Material------------ If yes,type ---------------------------- (Kot ________________ _______(Plot plan, showing-size of lot, location of system in relation to wells;"buildings, etc. must be paced on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,�)j PACKAGE TREATMENT j ] SEPTIC TANK'le Size-': ___JY .�--X__�-- Liquid Depth ?_A? -------------- Capacity/1-:210-10------ _____________Capacity/1-:2Q-Q______ Typd��" Materia0!02t'ZT` No. Compartments - = s 00 le Distance to nearest: Well ,__�_0r�_--_-----___"__`____Foundation _/rI______________ Prop. Line _ _______._ LEACHING LINE [ No, of Lines _ .__.___._ ___#_ Length of each line--0-�_ Total Length / _Q................. 'D' Box __ Type Filter, Material � _--'1---Depth Filter,Material /57/y .0le Distance to nearest: Well _4o-40-Q_---_---- Foundation J-- ------------ Property Line /00______-_---- SEEPAGE PIT [ Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------I------------- ' ----------------------------Rock Size -------------------------------- Distance to nearest: Well`,__;_____________________________)_ a __Foundation -------------------- Prop. Line ______--_______.___.. , `i REPAIR/ADDITION(Prev. Sanitation Permit# --------------------�•-------^ F"-v" l:Date __________________________________) r "M Septic Tank (Specify Requirements) -------- ----------.:---------------------------------- -------------------------------------------------------------------- Disposal Field (Specify Requirements) -------- w s r- -. .z �t _._W_ J,r.� - t --------------------- - t------------------------------------------------------------ -- [Draw existing-and required addition on reverse side) I hereby certify that I have prepared this appiicafion acid-thar'?he;work will. be done in accordance with San Joaquin k 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California;" — I Signed __ ______ ._ ___ Owner By ----- s Y -- - -------------- ---- -- ------- Title -L1 •Cc '/ d (If other t an owner) L _ -a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --- --- ---- --- ---------- ----------------- - ----------------- DATE -----��'�'� 7 ------------ i , ,BUILDING PERMIT ISSUED ------- ------- ---------DATE -------------.--.-.---------- m;'ADDtTIdNAI:COMMENTS -------- -- ---- -------------`----- -------------------------------------------------------------- --------------------------------- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------- -------------` ------------------------ ----- - ------- --------- ----- - ----------------------------------------------------------- ---------- - f rr it Final Inspection by ��- -� -------------------- --- -- ---------Date -CCS~---�-- ----�- ----------- )' ( SAN JOAQUIN LOCAL HEALTH DISTRICT �. E. H. 9 1-'68 Rev. 5M �' µ