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FOR,OFFICE USE: — APPLICATION FOR SANITATION PERMIT ----------- w � �� • (Complete an Triplicate) Permit No- ---- -------------------------------------------------- p. D Date Issued _._�� -_7 ---- --------------------------------------------------- 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 the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules rad Regulations: r A1M cc1144A�' P a.- p. 1.1 f% ,5:�41. dam �� pw�� JOB ADDRESS/LOCATION f � - � /�,� > J NSUS TRACT --------------- ------ � a Owner's Name ------- d ' ----`-----------I---------------- ----------- ----- -Phone ---------------------- ------ ` i � ls' Fe � -------------' City { ` Address ------------------------------------•----- J�- `�!� �' --- License #6 - �� - --- Phone ---------------------•--•----- Contractor's Name - R . Installation will serve: Residence Apartment House❑ Comr_nercial :❑Trailer Court i❑ Motel ❑Other ------------------------------------ ----- Number of living units:,- __-_ Number of bedrooms �--___Garbage Grinder -- Lot Size - mer P_-___--_________-___-___ Water Supply: Public Systern,.and name ------------------------------------------------------------------j ------------------------------------------Privatw Character of soil to a depth of;3.�feet- Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam If i �yHardpan F-1Adobe F1 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 o seepagep ti p-ermitte-if public sewer is available within 200 feet,) PACKAGE TREATMENT l SEPTIC TANK'94 Size-7 ------------------- - Liquid Depth -----------,---- --0 Capacity ��------ Type +/j4, Material-�_/�t o_ �Na Co m ------------------ Prop. Line __� ______________I�� Distance to nearest: Well ______ __ ---------------------Fround�-�� Tota:-Len th ��.�..-------••-•-•-- � �Q LEACHING LINE [,Q No. of Lines!____, '------Length-of each-line--n 9 -.4 hv 'D' Box/-��--- Type Filter Materl--/ee -Depth Filter Matetigi �e� ------------------/.---------- _-- -- _ Foundation .��----- - -- Pr er Line. ---- --------------- Distance to nearest: Well !_ ___ - P tY �� SEEPAGE PIT ] Depth _M? J------ --- Diameter ; - Number a° -------------- Rock Filled Yes , No i❑ � Rock Size -��--__ Water Table Depth -- ---- - F1'r 1 Distance to nearest: Well ------.l_ Q---- _-i-----.-Foundafiion - f" --- - Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------�"r- '- Date ____-___---_____ ------+------- ) � r Septic Tank {Specify Requirements) i.................. I\, �Y Disposal Field (Specify Requirements) --------------I --------------- --I--------------------------- ' ------I--------- ----------- ------------11, -1------------------ of 0-1 '-----------------------------------------------------------------------=----------------------------------- (Draw esting and required addition on reverse side) ` 1x I hereby certify that 1 have prepared this application and that the work will be. one 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: J "I certify that in the performance of the work for which this permit is issued, I shall not. mploy my person in such manner as to become subject to Workman's Comp nsation laws of California." Signed - -------------- ---` ---------------------------------- Owner { , ----------------------------- Title ------ � --- -- BYIf er than own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - _ -',-- - f DATE ----- ------- ---/------ BUILDING PERMIT ISSUED ----------------------------------- - -----------------=----- ----_-DATE 7� ----ADDITIONAL COMMENTS ---------- �---� --- � -- ----------- ----- --- -------- --- ------- - --- ----------- ----- - --- ---------------------------------------------- -- --A- f- --- - --------------------- ------ - -- ---- ------------------ ------------Date --- .---------------------------------- --- - --- ----------------------- ------ ----- ---- rFinal Inspection by: --- SAN JOA IN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M