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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --2---- :-A ---------- -- ---------•-- ------------------ (Complete in Triplicate) --------------------------------------------- P Date issued ---------------------------------------------------------- lion This Permit Ex fres 1 Year From Date Issued ___ -------- ----- Application is hereby made to.the San aquin Local Health District for a permit to construct and install the work herein This application made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. T pp V, ` << { ... ,t -.. T --- -------- _CENUS TRACT ----------- JOB ---------- JOB ADDRESS/LOCATIONI- -1" _ _ Y - S4 \ - _ i i N1� N�Ci�•*,clti---------=------------------------- Phone --------------------------•-------- Owner's Name ' ----- -----------. City --------------I---- --------- ---------- ---------------------•-•------ t € License # - Phone --------------------•-----•--- 1 Contractor's Name"--- --- ----------------------------- " ---- i Installation will server Residence XApartment House-❑ Commercial ❑Trailer Court ;❑ 1 �u, Motel ❑ Other �7 gCra # _ Garbage Grinder -----fl_-_ Lot Size --------------- -- Number",of living units:_-.1 of bedrooms _ g F L ., Private ❑ Water Siupply. Pubiic System and -name ------------------------------ - i Peat ❑ Sand Loam Clay Loam ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Y ❑ I - y i ❑ Adobe Fill Material ___________ If yes,type ---------------------------- Hardpan {PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. muIf st be placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pit permuted if public sewer is available within 200 feet,) PACKAGE,TREATMENT ( ]' SEPTIC TANK:( ] Size------------------------ ---------- ------- Liquid Depth ---------------------•--- a �S'tl Capacityl -- ---------- -- Type -------------------- Material---------------- -�---No. Compartments Distance to nearest: Well ------------------------------------Foundation.---------------------- ---- --- ----------------•---------Foundation:---------------------- Prop. Line ---------- Length of each line------------------I-- Total Length -•---------- No. of Lines 9 LEACHING LINE [ ] - --------- - ,e th Filter Material ------------------------------------------- D' _____ - -------------•----------- �I `D' Box ------------ Type Filter Materia ------------------- p Distance to nearest: Well ---------------- = Foundation ----------- --- Property Line. ------------------•=---- SEEPAGE PIT [ ] Depth ___ Rock Filled Yes No`s " I Number E _ Diameter ------- -------= ------ Water Table Depth ---Rock Size -------------------------------- Distance to nearest: Well _________________________________ ------Foundation-------------------- Prop. Line ---------•--------- REPAIR. ADD1710 Prev. Sanitation Permit# -------- ---- --------- --------- - ----- Date --------•-- - ---------------------) Septic (Specify Requirements) ----------- ft-------------------- ] --------------------------------------------•---------- I -------------------------------------- Dis oral Fief (Specify Requirement )`- ---- ------------ --� 1-? x , & = -------------l---------------------- --------------------- ------------------------------------------------ ------------------- (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: certify that in the performance of the work for which this permit is issued, I shall of employ any person in such manner 1 Y as to becom ss blect to Workman's Compensati laws of California." Signed . -- c Owner . --- -- --- ------------ - - Title ---------- ------- -- ---------- ---- ----- -----•---------------- FOR -- - --------- By ------- --------------------------------------------------- - - - ------- . {If other than owner] FOR DEPARTMENT USE ONLY ` DATE ---- '"31.-`�p----------------- APPLICATION ACCEPTED BY ---- ----- --------------------- BUILDING PERMIT ISSUED ------=- ------ DATE ------ ADDITIONAL COMMENTS ------------- ------------------ ---------------•--------- --------------------- ----- - ------------------ ----------- - - - = -------------------- -------------- ----- � ) - ------------------- t r---------^ _ ...._.___— --- --------- ----------------------- - ---- Date -- ------..- --------------------------------- Final Inspection b " " - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. _--