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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ��__3 • � Permit No. ----------�----- - --{Complete in Triplicate} --------------------------------------------------------- _ _ Date issued -�-:��---• - ---------- This Permit Expires Year From bate lssued n� OCA_ 02� 15 r --------- -------------------- 1 the work herein rict a permit to construct Application is hereby made to the made compliance with County tOrd Ordinance No. 549 and ex stin nRules tand Regulations-. described. This application is mad P �/_ _�_lr�_�a '� CENSUS TRACT % .-.JOB ADDRESS/LOCATION - - - ;f hone ---------- --------------- --•------ Owner's Name --__0-` -�'----- ---�±C�?—C---------------.---- - -- ---------------- ------- Cit - ------- --------•---•-------•--•--- Address ----- -ff ��-------- _4----------------- - Y ------------------------------------ -- • Phone _ ""i icense # Contractor's Name -_- --- - - ---- - - - - - Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Capt Motel ❑Other -------------------------------------------- 3. 9 .7 Garbage Grinder ----------- Lot Size =-------------- -- -------------- _ � Number of living units:.... ------ Number of bedrooms ____------- --_--_-- Private Water Supply: Public System an _ name _ ------------------------ - pp y- Sand loam ❑ Clay Loam;] •� Character of soil to a depth of 3 feet: Sand❑ Silt 0 Clay ❑ Peat❑ Y -,- Fill Material _ Y tYp — N Hardpan ] Adobe El • _ If es; a _.-----=-----•-- ----- ---� Its buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to we g k NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i Size----ry`�-_?_�1----------------------- Liquid Depth __ " -•--- f PACKAGE TREATMENT { ] SEPTIC TANK ---- Material_ No. Compartments --------• = Capacity /'c�'"®8'----� - Type ---'----_----' .�, v Distance to nearest: Wel! - ----------- - - -----Foundation J P--------------- Prop. Line --�-----. ---.------ ___-�------ -- LEACHING LINE [ ] No. of Lines ____-4----------------- Length of each line____._.�127V----- ------ Total Length ---------------- 1-0 De th Filter Material ----��--------- -------- --------- D' Box __ �!a--- Type Filter Material A-If p E Distance to nearest. Well - $79 --- Foundation /G Property Line �---------•-----•-•--- �<Depth _�- - - � Rock Filled Yes No SEEPAGE PIT ------_ Diameter A- -- Number ----------- � ] S--- Water Table Depth ------ --------------Rock Size --- - --- ------ • --------------------- ��' Foundation ! "- Prop. Line -•• -•------• -----•- r Distance-to nearest: Well --_ .________----------------- • ------ -- Date -------------------•--------------1 REPAIR/ADDITION(Prev. Sanitation Permit ----------------- ----------------- Septic Tank (Specify Requirements) --------------------------- - -------------------------------------------------------------------------- Septic -------------- - ------- ---------------------------- Disposal Field (Specify Requirements ------------------------------- --------------------- - --- ----------------------------- ------------------------------- ------------------- • - _ w_ .__ _ (Draw existing and required-addition on reverse-side]_ ��,,� e in ce I hereby certify that I have prepared this application and that the work will San Joaquin be clan laHealth bistrctnHometowner or h Son tc�nn County Ordinances, State Laws, and Rules and Regulations of sed agents signature certifies the following: erson in such manner "I certify that in the performance of the work for which this permit is issued, l shall not employ any p as to become subje/ct�to Workman's Compensation laws of California." �Sf _ _ -�-�- � Owner Signed f-_ _, -- ---------------------- ------------------------------------------------------------------------------------ - itle --- --------------------------------------- ------------------------- (If other than owned FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY __ ------------------------ - __- ---� _ ------------- BUILDING PERMIT ISSUED -------- ------------------ DATE ADDITIONAL COMMENTS ------------------------------------------------------------------------- -------- -------- -------- ------------ --------------------------------------------------- d --------------- --------------------------------------------------------------- ------ ------------- SAN - -------- --------------------- to Final Inspection by: __-- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M